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Home oxygen therapy in infants with bronchopulmonary dysplasia: a prospective study
E Baraldi1, S Carra, F Vencato
1Department of Paediatrics, University of Padova, Padua, Italy. eugi@child.pedi.unipd.it
Insights
Home oxygen therapy allows for the safe early discharge of infants with bronchopulmonary dysplasia (BPD), reducing hospital stays and costs. This approach supports infants requiring ongoing oxygen support, demonstrating significant financial savings.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Home Healthcare
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants, often requiring prolonged hospitalization and oxygen support.
- Early discharge with home oxygen therapy (HOT) is a strategy to manage BPD infants, balancing clinical needs with resource utilization.
Purpose of the Study:
- To evaluate the safety and efficacy of a prospective home oxygen therapy program for infants with bronchopulmonary dysplasia.
- To assess clinical outcomes, including cardiorespiratory function, growth, and rehospitalization rates, in infants receiving home oxygen therapy.
Main Methods:
- Prospective follow-up of 21 infants with BPD receiving home oxygen therapy via nasal cannula.
- Regular monitoring of oxygen saturation (SatO2), cardiac function (Doppler echocardiography), and respiratory mechanics (occlusion technique).
- Ophthalmological follow-up and assessment of growth and rehospitalization rates.
Main Results:
- Home oxygen therapy enabled safe early discharge, with a mean duration of 97 days.
- While some infants showed initial signs of right ventricular hypertrophy and pulmonary hypertension, these resolved in most by 12 months.
- No significant relationship was found between respiratory mechanics and oxygen therapy duration; however, weight gain was below the 3rd percentile.
- Retinopathy of prematurity did not worsen, and resolved in most infants by 12 months.
- Significant hospital days (2025) and associated costs were saved.
Conclusions:
- Home oxygen therapy is a safe and effective strategy for the early discharge of oxygen-dependent BPD infants.
- This approach leads to substantial reductions in hospital length of stay and considerable financial savings.
- Long-term cardiorespiratory outcomes were generally favorable, with resolution of initial abnormalities in most cases.
Unlabelled:
We followed the clinical course of 21 infants with bronchopulmonary dysplasia enrolled in a prospective home O2 therapy programme during a 4-year-period. Mean gestational age was 28.5 weeks (range, 25-36 weeks) and mean birth weight 1093 g (range 630-2750 g). Infants were regularly monitored to maintain pulse oximeter O2 saturation over 94%-95%. The source of O2 was liquid oxygen and was delivered by nasal cannula. During the follow up oxygenation was assessed by SatO2 measurement, cardiac function by Doppler echocardiography and respiratory function by the occlusion technique. All patients had an ophthalmological follow up. The mean age of the infants at discharge was 3.7 months (range 1.7-8.6) and mean weight 2830 g (range 2150-3780 g). At discharge 8 infants had right ventricular hypertrophy (RVH) and four of them had pulmonary hypertension. Mean duration of home O2 therapy was 97 days (range 15-320 days) and the mean age of discontinuation of O2 was 6.9 months (range 3-14.7 months). The cardiological follow up was benign: the ECG signs of RVH disappeared by 12 months of age in six out of eight infants and the right ventricular pulmonary pressure, as measured by the Doppler method, normalised in the four patients in whom it was detected. No relationship was found between respiratory mechanics and the duration of O2 therapy. Weight gain was poor with mean growth at the 3rd percentile for females and just below the 3rd percentile for males. Twelve of the 21 infants required 25 rehospitalizations. No one presented deterioration of retinopathy of prematurity that was present in 16 infants at discharge; at 12 months retinopathy was resolved in 14 infants. A total of 2025 hospital days were saved, representing a significant financial saving.
Conclusion:
Home O2 therapy permits the safe early discharge of O2-dependent BPD infants and it reduces significantly the length of time spent in hospital which represents a considerable financial saving.