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A family-centric, comprehensive nurse-led home oxygen programme for neonatal chronic lung disease: home oxygen policy
Nele Legge1,2, Dominic Fitzgerald1,3, Jacqueline Stack2,4
1University of Sydney, Camperdown, Australia.
Insights
A new policy for supplemental oxygen therapy in infants with neonatal chronic lung disease (nCLD) was successfully implemented. This approach reduced the number of infants requiring home oxygen therapy (HOT) after hospital discharge.
Area of Science:
- Neonatal medicine
- Pediatric pulmonology
- Respiratory care
Background:
- Neonatal chronic lung disease (nCLD) management post-discharge lacks standardized guidance.
- Supplemental oxygen therapy (SOT) use varies significantly among infants with nCLD.
- Objective evidence is limited for optimizing SOT in this population.
Purpose of the Study:
- To implement and evaluate a new policy for supplemental oxygen therapy in infants with nCLD.
- To utilize regular oximetry downloads for guiding SOT commencement and titration.
- To improve safety, practice uniformity, and outcomes, including home oxygen therapy (HOT) rates and length of stay (LOS).
Main Methods:
- A single-centre pre- and post-implementation study.
- Inclusion of infants <32 weeks' gestation diagnosed with nCLD.
- Primary outcomes: policy implementation success, changes in HOT rates, and LOS.
Main Results:
- The new policy was successfully implemented, with 100% of infants receiving oximetry downloads.
- The percentage of infants discharged on HOT decreased significantly from 36% pre-implementation to 17% post-implementation (p=0.03).
- No significant differences were observed in LOS or secondary outcomes.
Conclusions:
- A protocolized approach to SOT decision-making in neonates with nCLD is practical and achievable.
- This policy may lead to a reduction in the number of neonates requiring HOT.
- Standardized protocols can enhance care for infants with nCLD.
Objectives:
Considerable variation and little objective evidence exists to guide the use of supplemental oxygen therapy in infants with neonatal chronic lung disease (nCLD) after hospital discharge. We developed a new policy utilizing regular oximetry downloads to help determine commencement and titration of low flow oxygen. The aim of this policy is to improve safety and uniformity in practice and potentially lead to improvements in outcomes including the number of infants being discharged on home oxygen therapy (HOT) and length of stay (LOS).
Methods:
This single-centre pre- and post-implementation study included 86 and 94 infants <32 weeks' gestation (pre- vs. post-implementation) meeting definition of nCLD. The primary outcomes were (1) successful implementation of the new policy, (2) changes in number of patients discharged on HOT and (3) in LOS. Secondary outcomes were changes in feeding mode at discharge, total length of HOT, readmission to hospital within the first year of life and neurodevelopmental outcomes at 8 months post menstrual age amongst infants treated with HOT.
Results:
The policy was successfully implemented with 100 % of infants with nCLD receiving downloads in the post-implementation epoch. Pre-implementation 36 % (31 of 85) of infants with nCLD were treated with HOT vs. 17 % (16 of 94) post-implementation (p=0.03). There was no significant difference in LOS or any of the secondary outcomes.
Conclusions:
A protocolised approach to decision making using predetermined parameters regarding the need for supplemental oxygen in neonates with nCLD is practical and achievable and may result in fewer neonates requiring HOT.
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