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Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
Retrospective analysis of referrals for hypoxic challenge testing in children born preterm
Anna Howells1, Mollie Riley2, Martin Samuels2
1Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK anna.howells3@nhs.net.
Insights
Children with bronchopulmonary dysplasia (BPD) may need oxygen during air travel. Current testing criteria might miss at-risk children, indicating a need for better assessment before flights.
Area of Science:
- Pediatric Pulmonology
- Aeromedical Physiology
- Clinical Respiratory Research
Background:
- Children with bronchopulmonary dysplasia (BPD) face hypoxemia risks at altitude.
- Preflight hypoxic challenge testing (HCT) assesses oxygen needs for air travel.
- British Thoracic Society (BTS) guidelines (2011) inform HCT referral.
Purpose of the Study:
- Compare HCT outcomes in BPD children based on 2011 BTS criteria adherence.
- Identify predictors of HCT outcomes in children with BPD history.
- Evaluate the effectiveness of current referral criteria for HCT.
Main Methods:
- Retrospective analysis of HCT data (2006-2020) in children with BPD history.
- Exclusion criteria: respiratory comorbidities, ongoing oxygen therapy, repeat tests, incomplete records.
- Descriptive, univariate, and binary logistic regression analyses were performed.
Main Results:
- 79 HCTs analyzed; 30% did not meet BTS 2011 referral criteria.
- Higher desaturation rates observed in children not meeting criteria (46% vs 27%, non-significant).
- Higher baseline oxygen saturation predicted no need for oxygen during HCT, even after adjusting for confounders.
Conclusions:
- Current BTS referral criteria may inadequately identify children at risk of hypoxemia during air travel.
- Further research is needed to refine HCT referral criteria for BPD patients.
- Ensuring accurate preflight assessment is crucial for children with BPD history.
Introduction:
Children with a history of bronchopulmonary dysplasia (BPD) may be at risk of hypoxaemia at altitude, such as during air travel. We have performed preflight hypoxic challenge testing (HCT) since 2006, incorporating British Thoracic Society (BTS) guidance since 2011, to determine which children may require oxygen during air travel.
Aims:
We aimed to compare the outcome of HCTs in children with a history of BPD who met the 2011 BTS criteria and those who did not and, in addition to this, to interrogate the data for factors that may predict the outcome of HCT in this population.
Methods:
We performed a retrospective analysis of data from HCTs of children with a history of BPD referred 2006-2020. Cases were excluded if the patient had a respiratory comorbidity, was still on oxygen therapy, if the test was a repeat or if the clinical record was incomplete. Descriptive and univariate analysis of the data was performed, and a binary logistic regression model was fitted.
Results:
There were 79 HCTs, of which 24/79 (30%) did not meet BTS 2011 guidelines referral criteria. The analysis showed a greater proportion of desaturation in the group that did not meet criteria: 46% vs 27% (no statistical significance). Baseline oxygen saturations were higher in those who did not require oxygen during HCT and this variable was significant when adjusted for confounders.
Conclusions:
This study found that the current criteria for referral for preflight testing may incorrectly identify those most at risk and highlights the need for further investigation to ensure those most at risk are being assessed prior to air travel.
