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Enzer KG, Baker CD, Wisniewski BL. Bronchopulmonary Dysplasia. Clin Chest Med 2024; 45:639-650. [PMID: 39069327 DOI: 10.1016/j.ccm.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease, associated with premature birth, that arises during the infantile period. It is an evolving disease process with an unchanged incidence due to advancements in neonatal care which allow for the survival of premature infants of lower gestational ages and birth weights. Currently, there are few effective interventions to prevent BPD. However, careful attention to BPD phenotypes and comprehensive care provided by an interdisciplinary team have improved care. Interventions early in the disease course hold promise for improving long-term survival and outcomes in adulthood for this high-risk population.
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Affiliation(s)
- Katelyn G Enzer
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado School of Medicine, 13123 East 16th Avenue Box B-395, Aurora, CO 80045, USA.
| | - Christopher D Baker
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado School of Medicine, 13123 East 16th Avenue Box B-395, Aurora, CO 80045, USA
| | - Benjamin L Wisniewski
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado School of Medicine, 13123 East 16th Avenue Box B-395, Aurora, CO 80045, USA
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Leon-Astudillo C, Dy FJ, McCown MY, Perez IA, Chhabra D, Bansal M, Maloney MA, Bedoya M, Ezmigna D, Bush D, Okorie CUA, Gross JE. ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants. Pediatr Pulmonol 2024; 59:1552-1568. [PMID: 38545994 DOI: 10.1002/ppul.26961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/13/2024] [Accepted: 03/06/2024] [Indexed: 05/28/2024]
Abstract
The American Thoracic Society Core Curriculum updates clinicians annually in pediatric pulmonary disease. This is a summary of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2023 American Thoracic Society International Conference. The respiratory disorders of infancy discussed in this year's review include: the care of the patient with bronchopulmonary dysplasia in the neonatal intensive care unit, clinical phenotypes and comorbidities; diffuse lung disease; pulmonary hypertension; central and obstructive sleep apnea. The care of infants with respiratory disorders often poses significant challenges to the general pediatric pulmonologist, sleep clinician, and neonatologist. This review aims to highlight the most clinically relevant aspects of the evaluation, management, and outcomes of infants with these key respiratory disorders, while emphasizing the importance of multidisciplinary care. Furthermore, this document summarizes essential aspects of genetic testing, novel imaging and treatment modalities, and includes multiple resources for clinical practice.
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Affiliation(s)
- Carmen Leon-Astudillo
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Fei J Dy
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Michael Y McCown
- Department of Pediatrics, Inova Children's Hospital, Fairfax, Virginia, USA
| | - Iris A Perez
- Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Divya Chhabra
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Manvi Bansal
- Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Melissa A Maloney
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mariana Bedoya
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Monroe Carrell Jr. Children's Hospital of Vanderbilt, Nashville, Tennessee, USA
| | - Dima Ezmigna
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Douglas Bush
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Caroline U A Okorie
- Department of Pediatrics, Stanford Children's Health, Stanford, California, USA
| | - Jane E Gross
- Departments of Pediatrics and Medicine, National Jewish Health, Denver, Colorado, USA
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Yousif D, Cerini C, Ward S, Iyer N, Kato R, Durazo-Arvizu R, Bansal M. Retrospective study of serial polysomnograms of bronchopulmonary dysplasia patients with oxygen dependence. Pediatr Pulmonol 2024; 59:1418-1427. [PMID: 38411384 DOI: 10.1002/ppul.26930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/29/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION This retrospective study describes characteristics of serial polysomnograms (PSGs) of BPD patients on home oxygen therapy and describes PSG parameters associated with discontinuation of supplemental oxygen. METHODS A single-center study was performed at Children's Hospital Los Angeles, where serial PSGs for 44 patients with BPD infants discharged on home oxygen therapy were extracted for maximum of five PSGs or until oxygen discontinuation. Clinical and polysomnography data was collected. Characteristics of PSG1 were compared amongst the patients who were weaned from oxygen after PSG2 and PSG3. RESULTS Of 44 patients, 68.2% of patients were males with median birth gestational age of 26 weeks (IQR: 24.6-28.1), median birthweight of 777.5 g (IQR: 632.5-1054 g) and 77.3% of the cohort had severe BPD. A total of 138 PSGs were studied between all 44 patients serially. When comparing PSG1 and PSG2 parameters, statistically significant improvement was noted in multiple parameters. Median baseline SpO2, peak RR, and average PETCO2 were found to be potential predictors of prolonged oxygen use. Gestational age and birth weight were not associated with prolonged oxygen use after PSG3. The median age of oxygen discontinuation was calculated to be about 2 years of age. CONCLUSIONS The severity of hypoxia and tachypnea on initial infant PSG are associated with prolonged oxygen therapy past 2 years of age. Growth and development of lungs with maturation of control of breathing help improve these parameters over time regardless of BPD severity. The study may inform discussions between providers and parents for patients discharged home on oxygen therapy.
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Affiliation(s)
- Deena Yousif
- Department of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles-University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Chiara Cerini
- Department of Pediatrics, Children's Hospital Los Angeles-University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Sally Ward
- Department of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles-University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Narayan Iyer
- Department of Neonatology, Children's Hospital Los Angeles-University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Roberta Kato
- Department of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles-University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ramon Durazo-Arvizu
- Biostatistics Core The Saban Research Institute, Children's Hospital Los Angeles-University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Manvi Bansal
- Department of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles-University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Fitzgerald DA. The infant with bronchopulmonary dysplasia on home oxygen: The oxygen weaning conundrum in the absence of good evidence. Paediatr Respir Rev 2023; 47:11-15. [PMID: 36822990 DOI: 10.1016/j.prrv.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
Bronchopulmonary dysplasia [BPD] is the most common complication of extremely preterm delivery and its optimal management remains challenging because of a lack of evidence to guide management. There has been improvement in the management of evolving BPD in the neonatal intensive care unit (NICU). The threshold for provision of home oxygen therapy, often occurring because of a preference for earlier discharge from the NICU, creates tensions for clincians and families. Once discharged in supplemental oxygen, the approaches for the weaning of this therapy vary considerably across the world. Regardless of guidelines and multidisciplinary team support, up to a third of families of an infant with BPD elect to withdraw home oxygen therapy independently of medical advice. There is a pressing need to derive evidence to better inform practice, generate international consensus and undertake large, appropriately funded, longitudinal studies of BPD with clinically meaningful outcomes (respiratory, cardiovascular and neurodevelopmental) from infancy to adulthood.
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Affiliation(s)
- Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; Discipline of Child and Adolescent Health, Faculty of Medicine, Division of Health Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
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Sunkonkit K, Alzaid M, Xiao L, Massicotte C, Al-Saleh S, Amin R. Polysomnography in hospitalized children: Characteristics and clinical practice at a single tertiary care center. Pediatr Pulmonol 2023; 58:2637-2646. [PMID: 37378456 DOI: 10.1002/ppul.26567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Polysomnography (PSG) is the gold standard for the diagnosis of pediatric sleep-disordered breathing (SDB). However, the literature characterizing the indications for inpatient PSGs and the impact on clinical decision-making is limited. OBJECTIVE To determine the indications, results, and outcomes for children undergoing inpatient PSGs at our institution. METHODS We performed a retrospective review of children aged 0-18 years who underwent inpatient diagnostic PSGs between July 2018 and July 2021 at SickKids, Toronto, Canada. Baseline characteristics, indications, and management were reviewed and characterized by descriptive statistics. RESULTS Eighty-eight inpatient PSGs were performed in 75 children (male 62.7%). Median (interquartile range) age and body mass index z-score were 1.5 (0.2, 10.8) years and 0.27 (-1.58, 2.66), respectively. The most common indication for inpatient PSG was initiation and titration of ventilation (n = 34/75, 45.3%). Of the 75 children, 48 (64%) had multiple complex chronic conditions (CCCs). Sixty children (80%) underwent a baseline PSG for either the entire night or a portion of the night. Of these studies, 54 (90%) had clinically significant SDB of which isolated obstructive sleep apnea (OSA; 17/60, 28.3%) was the most common. The following management was undertaken for the 54 patients with SDB; respiratory technology (88.9%), surgical intervention (31.5%), positional therapy (1.9%), intranasal steroids (3.7%), and no further intervention (5.6%), respectively. CONCLUSIONS Our study highlights that inpatient PSG was an important diagnostic tool resulting in directed medical and surgical management. Future multicenter studies are needed to compare indications for inpatient PSGs across institutions to develop evidence-based clinical practice guidelines.
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Affiliation(s)
- Kanokkarn Sunkonkit
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pulmonary and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mohammed Alzaid
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatric Pulmonary, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Lena Xiao
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Colin Massicotte
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Lagatta JM, Zhang L, Yan K, Dawson S, Msall ME, Ambalavanan N, Brousseau DC. Prospective Risk Stratification Identifies Healthcare Utilization Associated with Home Oxygen Therapy for Infants with Bronchopulmonary Dysplasia. J Pediatr 2022; 251:105-112.e1. [PMID: 35934128 DOI: 10.1016/j.jpeds.2022.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test whether prospective classification of infants with bronchopulmonary dysplasia identifies lower-risk infants for discharge with home oxygen who have fewer rehospitalizations by 1 year after neonatal intensive care unit discharge. STUDY DESIGN This is a prospective single-center cohort that included infants from 2016 to 2019 with bronchopulmonary dysplasia, defined as receiving respiratory support at 36 weeks of postmenstrual age. "Lower-risk" infants were receiving ≤2 L/min nasal cannula flow, did not have pulmonary hypertension or airway comorbidities, and had blood gas partial pressure of carbon dioxide <70 mm Hg. We compared 3 groups by discharge status: lower-risk room air, lower-risk home oxygen, and higher-risk home oxygen. The primary outcome was rehospitalization at 1 year postdischarge, and the secondary outcomes were determined by the chart review and parent questionnaire. RESULTS Among 145 infants, 32 (22%) were lower-risk discharged in room air, 49 (32%) were lower-risk using home oxygen, and 64 (44%) were higher-risk. Lower-risk infants using home oxygen had rehospitalization rates similar to those of lower-risk infants on room air (18% vs 16%, P = .75) and lower rates than higher-risk infants (39%, P = .018). Lower-risk infants using home oxygen had more specialty visits (median 10, IQR 7-14 vs median 6, IQR 3-11, P = .028) than those on room air. Classification tree analysis identified risk status as significantly associated with rehospitalization, along with distance from home to hospital, inborn, parent-reported race, and siblings in the home. CONCLUSIONS Prospectively identified lower-risk infants discharged with home oxygen had fewer rehospitalizations than higher-risk infants and used more specialty care than lower-risk infants discharged in room air.
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Affiliation(s)
- Joanne M Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Ke Yan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Sara Dawson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Michael E Msall
- Department of Pediatrics, University of Chicago, Chicago, IL
| | | | - David C Brousseau
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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Singh J, Yeoh E, Castro C, Uy C, Waters K. Polysomnography in infants with clinical suspicion of sleep-related breathing disorders. J Clin Sleep Med 2022; 18:2803-2812. [PMID: 35959947 PMCID: PMC9713917 DOI: 10.5664/jcsm.10222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Limited data exist concerning the indications, parameters, utility of daytime polysomnography, and treatment of infants with suspected sleep-related breathing disorders. METHODS We retrospectively reviewed all polysomnography undertaken in a quaternary pediatric hospital for term infants up to 6 months of age between January 2017 and December 2019. Outcomes were evaluated, including a comparison among diagnostic groups. RESULTS Of 161 infants (58% male), 77 (48%) were ≤ 2 months old, and 103 (61%) were referred for either craniofacial abnormalities or an airway malformation. Daytime (n = 100) vs nighttime (n = 61) studies showed no differences in sleep architecture or treatment rates. Apnea-hypopnea index was > 10 events/h in 137 (85%) and was similar across different diagnostic groups, and 97 (78%) were prescribed noninvasive ventilation, with a mean treatment duration of 13.4 ± 9 months. Of the infants who were commenced on noninvasive ventilation 75% did not require it beyond 24 months. CONCLUSIONS Polysomnographic sleep parameters and the number of treatments prescribed were equivalent whether the polysomnography was performed during daytime or nighttime. Treatment with noninvasive ventilation was required in the short term for most infants with sleep-related breathing disorders, regardless of the indication for referral. CITATION Singh J, Yeoh E, Castro C, Uy C, Waters K. Polysomnography in infants with clinical suspicion of sleep-related breathing disorders. J Clin Sleep Med. 2022;18(12):2803-2812.
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Affiliation(s)
- Jagdev Singh
- Department of Respiratory Medicine and Sleep Medicine, The Children’s Hospital at Westmead, Sydney NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Eugene Yeoh
- Department of Respiratory Medicine and Sleep Medicine, The Children’s Hospital at Westmead, Sydney NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Chenda Castro
- Department of Respiratory Medicine and Sleep Medicine, The Children’s Hospital at Westmead, Sydney NSW, Australia
| | - Carla Uy
- Department of Respiratory Medicine and Sleep Medicine, The Children’s Hospital at Westmead, Sydney NSW, Australia
| | - Karen Waters
- Department of Respiratory Medicine and Sleep Medicine, The Children’s Hospital at Westmead, Sydney NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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House M, Klein S, Parham D, Hysinger EB, Brady JM. Frequent hypoxemia found in infants with bronchopulmonary dysplasia after weaning home oxygen. Pediatr Pulmonol 2022; 57:2638-2645. [PMID: 35832023 DOI: 10.1002/ppul.26076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/29/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Parental reports and brief clinical examinations are the primary information used to assist clinicians in weaning home supplemental oxygen in infants with bronchopulmonary dysplasia (BPD). Recorded nocturnal oximetry provides an objective assessment of hypoxemia; however, it is unknown if it identifies clinically undetected hypoxemia in the home setting. Our objective was to determine if nocturnal oximetry can identify unreported hypoxemia in infants with BPD who appear ready to wean from supplemental oxygen. STUDY DESIGN We conducted a retrospective chart review of infants born <32 weeks gestation with BPD who were discharged to home receiving supplemental oxygen and completed recorded nocturnal oximetry in room air during an 18-month period. Abnormal oximetry was defined as >5 min with SpO2 < 90% and/or an oxyhemoglobin desaturation index (ODI4) >5. Comparative analysis of patients with normal and abnormal overnight oximetry was performed using Fisher Exact and Wilcoxon signed-rank test. RESULTS Thirty-five former premature infants completed nocturnal oximetry at 5.8 (3.4-8.3) months corrected age. Nocturnal oximetry was abnormal as defined in 67% of the cohort (n = 21). Five percent of patients were hypoxemic, 52% had frequent desaturation events, and 43% had both. No significant differences existed in neonatal characteristics between patients with normal and abnormal studies. CONCLUSIONS Nocturnal oximetry was abnormal in the majority of infants with BPD who were otherwise clinically ready to wean from oxygen support, suggesting that recorded home oximetry could be a feasible and useful tool to evaluate for otherwise clinically unapparent nocturnal hypoxemia in patients with BPD.
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Affiliation(s)
- Melissa House
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sarah Klein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Danielle Parham
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Erik B Hysinger
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer M Brady
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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White H, Sobelman C, Kremer T, Lee A, Rhein LM. Does recorded oximetry utilizing a consensus-based algorithm compare to polysomnography in discontinuing home oxygen therapy in premature infants? Pediatr Pulmonol 2022; 57:476-482. [PMID: 34811971 DOI: 10.1002/ppul.25770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/10/2021] [Accepted: 11/05/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Approximately a third of all extremely preterm infants diagnosed with bronchopulmonary dysplasia will require home oxygen therapy (HOT). Lack of consensus-based guidelines has led to significant variability in outpatient HOT management in the United States. A common assessment performed before discontinuing oxygen is a formal polysomnogram (PSG). PSGs are potentially undesirable due to cost, lack of convenient access, and parental stress, so alternative testing to determine the optimal timing of safe oxygen discontinuation are needed. METHODS We compared nocturnal recorded home oximetry (RHO) with PSG data in a cohort of patients from the RHO trial for patients who had recordings performed simultaneously to or within 24 h of their PSG. The RHO trial was a randomized, unblinded, multi-center trial comparing two oxygen management strategies. Parameters of oxygenation were compared between PSG and RHO, and nonoximegtry findings from the PSG that changed clinical management were identified. RESULTS A total of 53 infants randomized to obtain a PSG as part of the RHO trial (55%) completed a PSG, and of those, 32 (64%) completed both a PSG with comparison RHO. There were more white infants in both groups than other races and ethnicities. Bland-Altman analysis showed a strong agreement of oxygen saturation time below 90% SpO2 between PSG and RHO results (slope = 1.014, p = 0.24). Results agreed in 96% of cases. CONCLUSION RHO is a safe and effective alternative to PSG to assist in determination of discontinuing HOT in infants with BPD without other risks for sleep-disordered breathing.
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Affiliation(s)
- Heather White
- Division of Neonatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Division of Pediatric Pulmonology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Celia Sobelman
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ted Kremer
- Division of Pediatric Pulmonology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Austin Lee
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lawrence M Rhein
- Division of Neonatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Division of Pediatric Pulmonology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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