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Şiklar Z. Management of endocrinological problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2163-2169. [PMID: 38088200 DOI: 10.1002/ppul.26800] [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: 07/04/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Children with home invasive mechanical ventilation (HIMV) face numerous difficulties, including endocrine problems that can arise as a consequence of their condition. Endocrine problems seen in children treated with HIMV may develop due to the underlying disease, drugs used, or prolonged mechanical ventilation. METHOD This manuscript will review the most common endocrine problems encountered in children with HIMV, including problems in glucose metabolism, thyroid dysfunction, bone metabolism, adrenal dysfunctions, growth, and puberty. CONCLUSION Close monitoring, multidisciplinary care, and regular assessments are essential to optimize the endocrine system functions of children requiring home mechanical ventilation. By understanding these complications, it can develop effective management strategies to optimize the health and well-being of these vulnerable individuals.
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Affiliation(s)
- Zeynep Şiklar
- Division of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
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2
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De Pieri C, Fauroux B, Khirani S, Thierry B, Delacourt C, Cogo P, Amaddeo A. Respiratory polygraphy in children with bronchopulmonary dysplasia: a retrospective study. Minerva Pediatr (Torino) 2024; 76:350-356. [PMID: 33305917 DOI: 10.23736/s2724-5276.20.06088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Periodic assessment of the need for oxygen supplementation and/or mechanical ventilation in children with severe bronchopulmonary dysplasia (BPD) is crucial. The aim of the study was to analyze the indications and results of respiratory polygraphies (RP) performed in preterm infants with BPD followed at a tertiary university hospital. METHODS All subjects <5-year-old with BPD who had a RP between September and February 2018 were included. The indications and results of RP and consequent medical management were analyzed. RESULTS Fourteen infants (9 females, mean gestational age 27.6±3.3 weeks) underwent a RP at mean age of 26.4±19.4 months. Five subjects were evaluated for the need of long-term respiratory support (RS), 3 started continuous positive airway pressure (CPAP), 2 were weaned from RS. Four subjects underwent RP for suspected obstructive sleep apnea (OSA), one started on CPAP. Central apnea syndrome (CSA) was confirmed in 2 subjects and one was started on non-invasive ventilation. RP allowed safe tracheostomy decannulation in 2 subjects. Finally, RP was normal in one subject who had a brief resolved unexplained event. CONCLUSIONS RP represents an important tool for the evaluation of children with BPD and leads to important therapeutic decisions.
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Affiliation(s)
- Carlo De Pieri
- Unit of Pediatric and Non-invasive Ventilation and Sleep, Necker-Enfants Malades Hospital, Paris, France
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Udine, Italy
| | - Brigitte Fauroux
- Unit of Pediatric and Non-invasive Ventilation and Sleep, Necker-Enfants Malades Hospital, Paris, France
- University of Paris, VIFASOM, Paris, France
| | - Sonia Khirani
- Unit of Pediatric and Non-invasive Ventilation and Sleep, Necker-Enfants Malades Hospital, Paris, France
- ASV Santé, Gennevilliers, France
| | - Briac Thierry
- Pediatric ENT Department, Necker-Enfants Malades Hospital, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pulmonology and Allergy, Necker-Enfants Malades Hospital, Paris, France
| | - Paola Cogo
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Udine, Italy
| | - Alessandro Amaddeo
- Unit of Pediatric and Non-invasive Ventilation and Sleep, Necker-Enfants Malades Hospital, Paris, France -
- University of Paris, VIFASOM, Paris, France
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Shen F, Wu X, Chen XL, Rong H, Yang Y. Family Integrated Care Shortens the Duration of Home Oxygen Therapy in Infants With Bronchopulmonary Dysplasia. Adv Neonatal Care 2024; 24:27-34. [PMID: 38113903 DOI: 10.1097/anc.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND There have been few reports on whether family integrated care (FIC) can help premature infants with moderate to severe bronchopulmonary dysplasia (BPD) to shorten the duration of home oxygen therapy (HOT). PURPOSE To investigate the effect of FIC on the duration of HOT in premature infants with moderate to severe BPD. METHODS The subjects were retrospectively selected from premature infants with moderate to severe BPD in our center between June 2019 and December 2021. Patients were divided into the FIC group (n = 47) and the non-FIC group (n = 34). For univariate analysis, t test, Mann-Whitney U test, Pearson χ 2 test, or Fisher exact test was performed to explore the differences between the 2 groups. For multivariate analysis, simple and multiple linear regression was conducted to explore the effect of FIC on the duration of HOT. RESULTS (1) The duration of HOT and length of stay after grouping were significantly shorter in the FIC group than in the non-FIC group ( P < .05). (2) The results of linear regression further revealed that FIC could significantly shorten the duration of HOT (simple linear regression, FIC [A] B : -12.709, 95% confidence interval (CI): -21.665 to -3.753; multiple linear regression, FIC [B] B : -11.419, 95% CI: -18.055 to -4.783). IMPLICATIONS FOR PRACTICE AND RESEARCH FIC improved the optimal target oxygen saturation ratio before discharge and shortened the duration of HOT in premature infants with moderate and severe BPD. FIC should be promoted in China's neonatal intensive care units, though it puts forward new requirements for nursing education and training.
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Affiliation(s)
- Fei Shen
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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4
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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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5
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Montealegre-Pomar ADP, Charpak N. Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants. Pediatr Pulmonol 2021; 56:1601-1608. [PMID: 33524247 DOI: 10.1002/ppul.25288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care Program (KMCP) with ambulatory oxygen, strict follow-up, and oxygen weaning protocols. OBJECTIVES (1) To describe growth, morbimortality, and oxygen monitoring up to 6 months in OD preterm infants. (2) To explore associations between oxygen weaning, perinatal history, Hb levels, transfusions, feeding patterns, and growth. METHODS A prospective cohort study. Descriptive and multivariate analysis. RESULTS Recruited patients were 407 with 33 weeks median gestational age (GA). Mothers presented infections >28%, pre-eclampsia in 22%, and 80% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age, and hospital stay were 36 weeks, 21 and 17 days, respectively; 56.8% of patients had neonatal sepsis and 67.8% were admitted to the neonatal intensive care unit. At oxygen weaning, patients had a median of 54 days with oxygen, median weight 3240 g and GA 41 weeks. Median follow-up oxygen saturation was 94% with 1/64-1/2 L/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 67% were breastfeeding. Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement while invasive ventilation and transfusions had the opposite effect (R2 = .49). CONCLUSIONS In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding, and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.
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Affiliation(s)
- Adriana Del Pilar Montealegre-Pomar
- Kangaroo Foundation, Bogotá, Colombia.,Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Nathalie Charpak
- Kangaroo Foundation, Bogotá, Colombia.,Pontificia Universidad Javeriana, Bogotá, Colombia
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Wong MD, Neylan M, Williams G, Zahir SF, Chawla J. Predictors of home oxygen duration in chronic neonatal lung disease. Pediatr Pulmonol 2021; 56:992-999. [PMID: 33621433 DOI: 10.1002/ppul.25257] [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: 09/20/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 11/07/2022]
Abstract
AIMS In infants with chronic neonatal lung disease (CNLD), we aimed to identify predictors of home oxygen duration, predictors of discharge oxygen flow rates, and the association of oxygen flow rates with respiratory outcomes. METHODS Infants with CNLD requiring home oxygen in 2016 and 2017 were retrospectively reviewed. Hazard ratios (HR) were estimated from Cox proportional hazards regression models in the cohort. A multinomial logistic regression model examined the effects of maternal and infant variables on discharge oxygen flow rates. Kruskal-Wallis test with univariate linear regression and Fisher's exact test with binomial univariate logistic regression were used to examine associations between oxygen flow groups and post-discharge clinical variables. RESULTS One hundred and forty-nine infants were included. Median corrected gestational age (CGA) at oxygen cessation was 6.8 months (interquartile range, 4.4) with 87.2% of infants weaned by 12 months CGA. Shorter initial neonatal intensive care unit (NICU) stay predicted faster oxygen weaning at 9 months (HR, 0.99; 95% confidence interval [CI], 0.98-1.00, p = .02) and 12 months (HR, 0.99; 95% CI, 0.98-1.00, p = .02). Infants with hypercarbia at discharge or discharged from NICU at higher CGA had higher odds of requiring ≥ 200 ml/min relative to ≤ 125 ml/min oxygen. Infants discharged with > 250 ml/min oxygen were more likely to have a respiratory-related admission before 2 years chronological age. CONCLUSION Shorter initial NICU stay was the best predictor of earlier home oxygen cessation. At NICU discharge, infants with hypercarbia or a higher CGA may require more home oxygen and experience more respiratory-related hospital admission in the first 2 years of chronological age.
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Affiliation(s)
- Matthew D Wong
- Pediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Melissa Neylan
- Pediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Gordon Williams
- Pediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Syeda F Zahir
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Jasneek Chawla
- Pediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
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Flores-Fenlon N, Wright N, Lew C, Stavroudis TA, Wee CP, Davidson Ward SL, Bansal M. Retrospective analysis of inpatient polysomnogram characteristics and discharge outcomes in infants with bronchopulmonary dysplasia requiring home oxygen therapy. Pediatr Pulmonol 2021; 56:88-96. [PMID: 33107696 PMCID: PMC8260179 DOI: 10.1002/ppul.25129] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/03/2023]
Abstract
RATIONALE Little is known about the polysomnogram (PSG) characteristics in infants with bronchopulmonary dysplasia (BPD), especially severe BPD, who do not need home ventilatory support but are at increased risk for chronic hypoxia and are vulnerable to its effects. OBJECTIVE This study aims to assess PSG characteristics and change in discharge outcomes in premature infants with BPD who required oxygen therapy at discharge. METHODS This is a retrospective chart review of premature infants with BPD who were admitted to a quaternary newborn and infant intensive care unit from January 1, 2012 to December 31, 2015 and who underwent polysomnography before discharge. MEASUREMENTS AND MAIN RESULTS Data from 127 patients were analyzed. The median gestational age of our patients was 26 weeks and 1 day (interquartile range [IQR]: 24.71, 28.86). The majority of the patients had moderate-to-severe BPD. The median obstructive apnea-hypopnea index was 5.3 events/h (IQR: 2.2, 10.1). The median oxygen desaturation index was 15.7 events/h (IQR: 4.7, 35). Nadir oxygen saturation measured by pulse oximeter was 81% (IQR: 76-86) and the arousal/awakening index was 21.9 (IQR: 13.3-30.9). No statistically significant difference was noted between severe and nonsevere BPD groups for PSG characteristics. However, average end-tidal CO2 was significantly higher in the severe BPD group (p = .0438). Infants in the severe BPD group were intubated longer than infants with nonsevere BPD (p = .0082). The corrected gestational age (CGA) at the time of discharge (CGA-PSG) and PSG (CGA-DC) was higher in severe BPD patients but not statistically different. The majority of premature infants who underwent a PSG were discharged home with oxygen, and 69% required a titration of their level of support based on results from the PSG. CONCLUSION Our results highlight the presence of abnormal PSG characteristics in BPD patients, as early as 43 weeks CGA. These findings have not been previously described in this patient population prior to initial discharge from the hospital. A severe BPD phenotype tends to be associated with higher respiratory morbidity compared with a nonsevere BPD phenotype for the comparable CGA. PSG, when available, may be helpful for individualizing and streamlining treatment in preparation for discharge home and mitigating the effects of intermittent hypoxic episodes.
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Affiliation(s)
- Nicole Flores-Fenlon
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Noah Wright
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Cheryl Lew
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Theodora A Stavroudis
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, Fetal and Neonatal Institute, University of Southern California, Los Angeles, California, USA
| | - Choo Phei Wee
- Southern California Clinical and Translational Science Institute (SC-CTSI), The Saban Research Institute (TSRI) Biostatistics Core, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Sally L Davidson Ward
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Manvi Bansal
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
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Rhein L, White H, Simoneau T, Traeger N, Lahiri T, Kremer T, Sheils C, Meyer K, Rosenkrantz T, Krishnan S, Hartman T, Feldman HA, Abu Jawdeh EG. Transmitted Home Oximetry and Duration of Home Oxygen in Premature Infants. Pediatrics 2020; 146:peds.2020-0079. [PMID: 32665372 DOI: 10.1542/peds.2020-0079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if a home oxygen therapy (HOT) management strategy that includes analysis of recorded home oximetry (RHO) data, compared with standard monthly clinic visit assessments, reduces duration of HOT without harm in premature infants. METHODS The RHO trial was an unmasked randomized clinical trial conducted in 9 US medical centers from November 2013 to December 2017, with follow-up to February 2019. Preterm infants with birth gestation ≤37 + 0/7 weeks, discharged on HOT, and attending their first pulmonary visit were enrolled. The intervention was an analysis of transmitted RHO between clinic visits (n = 97); the standard-care group received monthly clinic visits with in-clinic weaning attempts (n = 99). The primary outcomes were the duration of HOT and parent-reported quality of life. There were 2 prespecified secondary safety outcomes: change in weight and adverse events within 6 months of HOT discontinuation. RESULTS Among 196 randomly assigned infants (mean birth gestational age: 26.9 weeks; SD: 2.6 weeks; 37.8% female), 166 (84.7%) completed the trial. In the RHO group, the mean time to discontinue HOT was 78.1 days (SE: 6.4), compared with 100.1 days (SE: 8.0) in the standard-care group (P = .03). The quality-of-life scores improved from baseline to 3 months after discontinuation of HOT in both groups (P = .002), but the degree of improvement did not differ significantly between groups (P = .75). CONCLUSIONS RHO was effective in reducing the duration of HOT in premature infants. Parent quality of life improved after discontinuation. RHO allows physicians to determine which infants can be weaned and which need prolonged oxygen therapy between monthly visits.
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Affiliation(s)
- Lawrence Rhein
- Divisions of Neonatology and .,Pediatric Pulmonology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | | | - Tregony Simoneau
- Division of Pediatric Pulmonology, School of Medicine, University of Connecticut and Connecticut Children's Medical Center, Hartford, Connecticut
| | - Nadav Traeger
- Division of Pediatric Pulmonology, Maria Fareri Children's Hospital, Valhalla, New York
| | - Thomas Lahiri
- Division of Pediatric Pulmonology, Larner College of Medicine, The University of Vermont, Burlington, Vermont
| | - Ted Kremer
- Pediatric Pulmonology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Catherine Sheils
- Department of Medicine, Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts
| | - Kathleen Meyer
- Division of Neonatology, Baystate Health Center, Springfield, Massachusetts
| | - Ted Rosenkrantz
- Division of Neonatology, Department of Pediatrics, University of Connecticut Health, Farmington, Connecticut
| | - Sankaran Krishnan
- Division of Pediatric Pulmonology, Maria Fareri Children's Hospital, Valhalla, New York
| | - Tyler Hartman
- Division of Neonatology, Geisel School of Medicine, Dartmouth College, Manchester, New Hampshire
| | - Henry A Feldman
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts; and
| | - Elie G Abu Jawdeh
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
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Kapur N, Nixon G, Robinson P, Massie J, Prentice B, Wilson A, Schilling S, Twiss J, Fitzgerald DA. Respiratory management of infants with chronic neonatal lung disease beyond the NICU: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 25:880-888. [PMID: 32510776 PMCID: PMC7496866 DOI: 10.1111/resp.13876] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/16/2020] [Accepted: 05/21/2020] [Indexed: 12/17/2022]
Abstract
Chronic neonatal lung disease (CNLD) is defined as continued need for any form of respiratory support (supplemental oxygen and/or assisted ventilation) beyond 36 weeks PMA. Low-flow supplemental oxygen facilitates discharge from hospital of infants with CNLD who are hypoxic in air and is widely used despite lack of evidence on the most appropriate minimum mean target oxygen saturations. Furthermore, there are minimal data to guide the home monitoring, titration or weaning of supplemental oxygen in these infants. The purpose of this position statement is to provide a guide for the respiratory management of infants with CNLD, with special emphasis on role and logistics of supplemental oxygen therapy beyond the NICU stay. Reflecting a variety of clinical practices and infant comorbidities (presence of pulmonary hypertension, retinopathy of prematurity and adequacy of growth), it is recommended that the minimum mean target range for SpO2 during overnight oximetry to be 93-95% with less than 5% of total recording time to be below 90% SpO2 . Safety of short-term disconnection from supplemental oxygen should be assessed before discharge, with majority of infants with CNLD not ready for discharge until supplemental oxygen requirement is ≤0.5 L/min. Sleep-time assessment of oxygenation with continuous overnight oximetry is recommended when weaning supplemental oxygen. Palivizumab is considered safe and effective for the reduction of hospital admissions with RSV infection in this group. This statement would be useful for paediatricians, neonatologists, respiratory and sleep physicians and general practitioners managing children with CNLD.
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Affiliation(s)
- Nitin Kapur
- Department of Respiratory and Sleep MedicineQueensland Children's HospitalBrisbaneQLDAustralia
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Gillian Nixon
- Melbourne Children's Sleep CentreMonash Children's HospitalMelbourneVICAustralia
- Department of PaediatricsMonash UniversityMelbourneVICAustralia
| | - Philip Robinson
- Respiratory and Sleep MedicineRoyal Children's Hospital, Murdoch Children's Research InstituteMelbourneVICAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVICAustralia
| | - John Massie
- Department of Respiratory MedicineRoyal Children's HospitalMelbourneVICAustralia
| | - Bernadette Prentice
- Department of Respiratory MedicineSydney Children's HospitalSydneyNSWAustralia
| | - Andrew Wilson
- Department of Respiratory and Sleep MedicinePrincess Margaret Hospital for ChildrenPerthWAAustralia
| | - Sandra Schilling
- Department of Respiratory and Sleep MedicineQueensland Children's HospitalBrisbaneQLDAustralia
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Jacob Twiss
- Respiratory DepartmentStarship Children's HospitalAucklandNew Zealand
| | - Dominic A. Fitzgerald
- Discipline of Child and Adolescent Health, Faculty of Medicine and HealthUniversity of Sydney and the Children's Hospital at WestmeadSydneyNew South WalesAustralia
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10
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Haggie S, Robinson P, Selvadurai H, Fitzgerald DA. Bronchopulmonary dysplasia: A review of the pulmonary sequelae in the post-surfactant era. J Paediatr Child Health 2020; 56:680-689. [PMID: 32270551 DOI: 10.1111/jpc.14878] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/20/2020] [Accepted: 03/11/2020] [Indexed: 01/06/2023]
Abstract
We describe the respiratory complications of bronchopulmonary dysplasia (BPD) in childhood and adolescence. The pathophysiology of bronchopulmonary dysplasia has evolved in the era of modern neonatal intensive care. In this review, we aim to summarise the contemporary evidence base and describe the common respiratory morbidities related to BPD including; home oxygen therapy, rehospitalisation, asthma and exercise limitation.
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Affiliation(s)
- Stuart Haggie
- Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Robinson
- Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Abstract
Home oxygen therapy is increasingly prescribed for various conditions in the neonatal period, particularly for infants with bronchopulmonary dysplasia. Due to limited evidence on indication, minimal target oxygen saturation, monitoring, application and discontinuation of home oxygen therapy clinical practice varies widely throughout the world. International guidelines provide recommendations mostly on the basis of nonsystematic clinical observations. Most relevant points for the clinical management of home oxygen therapy include a minimal target oxygen saturation of equal to or greater than 93%, the provision of a home monitoring of oxygen saturation ideally with a memory function, and the conduct of continuous overnight oximetry or polysomnography during weaning from supplemental oxygen. This review summarizes relevant literature as well as existing guidelines and recommendations on home oxygen therapy to aid clinicians in the management of these patients and identifies areas for future research.
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Affiliation(s)
- Sabine Pirr
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Germany.
| | - Corinna Peter
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Germany.
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12
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Wong MD, Chung H, Chawla J. Using continuous overnight pulse oximetry to guide home oxygen therapy in chronic neonatal lung disease. J Paediatr Child Health 2020; 56:309-316. [PMID: 31464352 DOI: 10.1111/jpc.14606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
Abstract
AIM The aims of this study are: (i) to survey the knowledge of paediatric clinicians using overnight continuous pulse oximetry data to guide management of infants with chronic neonatal lung disease (CNLD); (ii) to assess the ability of paediatric clinicians to interpret overnight continuous pulse oximetry data; and (iii) to describe the overnight oximetry interpretation practices of paediatric respiratory specialists. METHODS Paediatric clinicians from three tertiary teaching hospitals completed an anonymous survey regarding overnight continuous pulse oximetry in chronic neonatal lung disease. Using a modified Delphi technique, paediatric respiratory specialists participated in a concordance exercise and discussions to establish consensus interpretations for 25 oximetry studies. Paediatric clinicians were invited to complete the same exercise as a comparison. RESULTS Self-rated knowledge from 74 surveyed clinicians was proportional to clinical experience. Twenty paediatric clinicians and nine paediatric respiratory specialists completed the oximetry exercise with scores of 64% (κ = 0.25) and 80% (κ = 0.45), respectively. Individual parameters like a mean peripheral arterial haemoglobin saturation (SpO2 ) below 93% and percentage time spent below SpO2 93% correlated poorly with the consensus interpretations. Paediatric respiratory specialists instead relied on visual analysis of SpO2 waveforms, utilising the frequency and depth of desaturations to guide management. CONCLUSION Interpretation of overnight oximetry data is variable amongst both paediatric clinicians and respiratory specialists. This likely reflects inadequate evidence defining clinically significant intermittent hypoxaemia, whether in terms of desaturation duration, frequency or nadir.
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Affiliation(s)
- Matthew D Wong
- Department of Paediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Hinfan Chung
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jasneek Chawla
- Department of Paediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Hayes D, Wilson KC, Krivchenia K, Hawkins SMM, Balfour-Lynn IM, Gozal D, Panitch HB, Splaingard ML, Rhein LM, Kurland G, Abman SH, Hoffman TM, Carroll CL, Cataletto ME, Tumin D, Oren E, Martin RJ, Baker J, Porta GR, Kaley D, Gettys A, Deterding RR. Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2019; 199:e5-e23. [PMID: 30707039 PMCID: PMC6802853 DOI: 10.1164/rccm.201812-2276st] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Home oxygen therapy is often required in children with chronic respiratory conditions. This document provides an evidence-based clinical practice guideline on the implementation, monitoring, and discontinuation of home oxygen therapy for the pediatric population. Methods: A multidisciplinary panel identified pertinent questions regarding home oxygen therapy in children, conducted systematic reviews of the relevant literature, and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach to rate the quality of evidence and strength of clinical recommendations. Results: After considering the panel’s confidence in the estimated effects, the balance of desirable (benefits) and undesirable (harms and burdens) consequences of treatment, patient values and preferences, cost, and feasibility, recommendations were developed for or against home oxygen therapy specific to pediatric lung and pulmonary vascular diseases. Conclusions: Although home oxygen therapy is commonly required in the care of children, there is a striking lack of empirical evidence regarding implementation, monitoring, and discontinuation of supplemental oxygen therapy. The panel formulated and provided the rationale for clinical recommendations for home oxygen therapy based on scant empirical evidence, expert opinion, and clinical experience to aid clinicians in the management of these complex pediatric patients and identified important areas for future research.
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Polysomnography in Preterm Infants with Bronchopulmonary Dysplasia for Monitoring Sleep-Disordered Breathing and Pulmonary Reserve. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00141-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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15
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Stress Oximetry: Description of a Test to Determine Readiness for Discontinuing Oxygen Therapy in Infants with Chronic Lung Disease. Int J Pediatr 2018; 2018:8151678. [PMID: 30271439 PMCID: PMC6151215 DOI: 10.1155/2018/8151678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/05/2018] [Accepted: 08/19/2018] [Indexed: 02/03/2023] Open
Abstract
Background In infants with CLD there are no objective tests to monitor an infant's progress towards weaning out of oxygen inhalation therapy (O2IT). A test involving staged maneuvers of increasing respiratory stress while decreasing oxygen support, termed Stress Oximetry (StressOx), has been used at our center for weaning O2IT. Objective To report the clinical utility of "StressOx" in evaluating readiness for discontinuing O2IT in infants with CLD. Methods A retrospective review was done of StressOx tests administered at our center from 2002-2008. StressOx was performed based on a consistent clinical protocol in all eligible infants on O2IT. O2IT was generally discontinued after infant had passed two StressOx tests and subsequently infants were monitored for a minimum of 7 days to determine successful weaning. Results There were 279 infants with 899 tests that met inclusion criteria. An average of 3 tests per infant was done, one week apart. The test had a specificity of 97.4% and a positive predictive value of 99.6% in determining success of discontinuing O2IT. Conclusions StressOx appears to be a clinically useful test that may help in determining an infant's ability to successfully wean out of O2IT. Further validation of this test is warranted.
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16
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Flint A, Davies MW. The use of overnight oximetry in neonates: A literature review. J Paediatr Child Health 2018; 54:720-727. [PMID: 29762884 DOI: 10.1111/jpc.13935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/04/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
There is much debate between neonatologists and paediatricians about appropriate oxygen saturation targets for babies with chronic neonatal lung disease (CNLD). Overnight oximetry is used to guide the fraction of inspired oxygen to use. We did this literature review to examine the current literature on the use of overnight oximetry in term infants, preterm infants and babies with CNLD (especially relevant to ex-preterm babies with CNLD going home on oxygen). We reviewed the literature from January 1990 to October 2017 by searching the following databases: Cochrane Central Register of Controlled Trials, The Joanna Briggs Institute, CINAHL, MEDLINE, Scopus, EMBASE, ProQuest and Science Direct. Sixteen articles were included in the review. The literature available on overnight oximetry in neonates is limited, it is not contemporary, and it reports studies that did not use oximeters with modern software for data collection and analysis. It is imperative that reference ranges be defined for overnight oximetry parameters so that babies are not inadvertently administered inappropriate amounts of oxygen.
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Affiliation(s)
- Anndrea Flint
- Department of Paediatrics, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - Mark W Davies
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia
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17
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Kulkarni G, de Waal K, Grahame S, Collison A, Roddick L, Hilton J, Gulliver T, Whitehead B, Mattes J. Polysomnography for the management of oxygen supplementation therapy in infants with chronic lung disease of prematurity. J Matern Fetal Neonatal Med 2018; 32:3640-3646. [PMID: 29695207 DOI: 10.1080/14767058.2018.1470234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aim: Some infants with bronchopulmonary dysplasia (BPD) may require oxygen supplementation at home but a role for overnight polysomnography (PSG) in the management of home oxygen therapy has been rarely described. Methods: Forty-one infants with BPD born at less than 30 weeks gestational age were discharged with continuous home oxygen supplementation therapy between 2010 and 2013. PSG data were recorded on oxygen supplementation versus room air at median corrected age of 2 months (range 1-5 months) (first PSG after discharge to home). Those infants who continued oxygen supplementation therapy at home had at least one more PSG before oxygen therapy was discontinued (last PSG). We also collected PSG data in 10 healthy term infants (median age 3.5 months; range 2-4 months). Results: In infants with BPD in room air, increased numbers of central apneas, hypopneas, and SaO2 desaturations were the predominant PSG features with a median apnea-hypopnea index (AHI) of 16.8 events per hour (range 0-155). On oxygen supplementation therapy, median AHI dramatically improved (2.2, range 0-22; p < .001) and was not different from control infants (2.0, range 0-3.9; p = .31). AHI on room air at the last PSG when home oxygen was ceased was 4.1 per hour (range 0-13.8) slightly higher than in healthy infants. Conclusion: Central sleep disordered breathing in infants with BPD dramatically normalizes with low flow nasal cannula home oxygen therapy and improves with age. Mild central sleep disordered breathing remains detectable, although much improved, when compared with healthy infants at the time when the decision to cease home oxygen therapy was made by the physician.
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Affiliation(s)
- Gaurav Kulkarni
- a Priority Research Centre GrowUpWell, University of Newcastle and Hunter Medical Research Institute , Newcastle , Australia.,b Department of Paediatric Respiratory and Sleep Medicine , John Hunter Children's Hospital , Newcastle , Australia
| | - Koert de Waal
- c Department of Neonatology , John Hunter Children's Hospital , Newcastle , Australia
| | - Sally Grahame
- b Department of Paediatric Respiratory and Sleep Medicine , John Hunter Children's Hospital , Newcastle , Australia
| | - Adam Collison
- a Priority Research Centre GrowUpWell, University of Newcastle and Hunter Medical Research Institute , Newcastle , Australia
| | - Laurence Roddick
- b Department of Paediatric Respiratory and Sleep Medicine , John Hunter Children's Hospital , Newcastle , Australia
| | - Jodi Hilton
- b Department of Paediatric Respiratory and Sleep Medicine , John Hunter Children's Hospital , Newcastle , Australia
| | - Tanya Gulliver
- b Department of Paediatric Respiratory and Sleep Medicine , John Hunter Children's Hospital , Newcastle , Australia
| | - Bruce Whitehead
- b Department of Paediatric Respiratory and Sleep Medicine , John Hunter Children's Hospital , Newcastle , Australia
| | - Joerg Mattes
- a Priority Research Centre GrowUpWell, University of Newcastle and Hunter Medical Research Institute , Newcastle , Australia.,b Department of Paediatric Respiratory and Sleep Medicine , John Hunter Children's Hospital , Newcastle , Australia
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Joosten K, de Goederen R, Pijpers A, Allegaert K. Sleep related breathing disorders and indications for polysomnography in preterm infants. Early Hum Dev 2017; 113:114-119. [PMID: 28711234 DOI: 10.1016/j.earlhumdev.2017.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a range of breathing problems which occur and may persist in preterm infants, such as central apneas, obstructive apneas and periodic breathing. Preterm infants may also suffer from respiratory distress syndrome and chronic lung disease necessitating prolonged use of oxygen therapy after discharge from the hospital. Due to these persistent breathing pattern abnormalities in preterm infants, there is a higher risk of altered sleep and apparent life threatening events. Polysomnography can be a helpful tool to identify those infants who have abnormalities in their breathing pattern, to identify those infants who have an increased risk to get a sleep related breathing event at home and to decide about the discontinuation of oxygen therapy.
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Affiliation(s)
- Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Pediatric Intensive Care, Rotterdam, The Netherlands.
| | - Robbin de Goederen
- Dutch Craniofacial Center, Department of Plastic, Reconstructive and Hand Surgery, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Angelique Pijpers
- Kempenhaeghe Academic Center for Epileptology, Sleep Medicine and Neurocognition, Heeze, The Netherlands
| | - Karel Allegaert
- Department of Pediatric Surgery, Erasmus University Medical Center - Sophia, Rotterdam, The Netherlands; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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19
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Hong T, Bolisetty S, Bajuk B, Abdel-Latif M, Oei J, Jaffe A, Lui K. A population study of respiratory rehospitalisation in very preterm infants in the first 3 years of life. J Paediatr Child Health 2016; 52:715-21. [PMID: 27203818 DOI: 10.1111/jpc.13205] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/29/2022]
Abstract
AIM Very premature infants consume healthcare resources following discharge from neonatal intensive care units (NICU). This study aimed to evaluate the burden of respiratory related rehospitalisation within the first 3 years post discharge in very premature infants in an Australian population. METHODS Rehospitalisation of a 4-year cohort of NICU survivors, born less than 32 weeks gestation, was derived from data linkage of three state-wide databases including NSW Neonatal Intensive Care Units' Data Collection, Admitted Patient Data Collection and the Death Registry. Rehospitalisation diagnoses were determined by ICD-10 AM codes. RESULTS Of the 2939 survivors, 525 (18%) had bronchopulmonary dysplasia (BPD) and 261 BPD infants (50%) were discharged on home oxygen. Almost two-third (1860, 63%) of the survivors are required rehospitalisation, respiratory causes, including 394 respiratory syncytial virus (RSV)-related, accounted for 2668 (48%) of the 5599 rehospitalisations. Significantly more home oxygen BPD survivors had respiratory (70%) and RSV-related (22%) rehospitalisations than the BPD infants not needing home oxygen (58% and 18%, respectively), and the survivors without BPD had the lowest rates (32% and 10%, P < 0.001). Most respiratory (61%) and RSV-related (74%) rehospitalisations occurred during the first 12 months post discharge. No RSV-related fatality occurred. Amongst the total 17 562 hospital days, respiratory and RSV-related admissions accounted for 10 905 (62%) and 3031 (17.2%) days. In multivariable logistic analyses, home oxygen and maternal indigenous status were independently associated with high (3 or more) respiratory and RSV rehospitalisation rates. CONCLUSIONS Respiratory rehospitalisations are common in very premature survivors. Home oxygen and indigenous status are significant risk factors for respiratory and RSV-related rehospitalisations.
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Affiliation(s)
- Timothy Hong
- Division of Newborn Services, Royal Hospital for Women, Sydney, Australia.,The Gold Coast Hospital, Gold Coast, Queensland, Australia
| | - Srinivas Bolisetty
- Division of Newborn Services, Royal Hospital for Women, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Barbara Bajuk
- NSW Pregnancy and newborn Services Network (PSN), Sydney, New South Wales, Australia
| | - Mohamed Abdel-Latif
- Department of Neonatology, Centenary Hospital, Canberra, Australian Capital Territory, Australia
| | - Julee Oei
- Division of Newborn Services, Royal Hospital for Women, Sydney, Australia
| | - Adam Jaffe
- Division of Newborn Services, Royal Hospital for Women, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Kei Lui
- Division of Newborn Services, Royal Hospital for Women, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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20
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Thompson K, Gardiner J, Resnick S. Outcome of outborn infants at the borderline of viability in Western Australia: A retrospective cohort study. J Paediatr Child Health 2016; 52:728-33. [PMID: 27149045 DOI: 10.1111/jpc.13187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 01/08/2023]
Abstract
AIM Preterm infants have a high risk of morbidity and mortality, which increases with decreasing gestational age. Inborn infants (infants born in tertiary perinatal centres) have higher survival and lower morbidity than outborn infants. We aimed to compare short-term and 1-year developmental outcomes of outborn infants at the borderline of viability (≥23 to ≤25 + 6 weeks gestation) with a similar cohort of inborn infants in the sole tertiary perinatal centre in Western Australia from 2001 to 2011. METHODS This was a retrospective cohort study. Outborn infants ≥23 to ≤25 + 6 weeks gestation who survived to be transported to the Neonatal Intensive Care Unit (NICU) in the perinatal centre were contemporaneously matched to the next inborn infant of comparable gestation and birth weight. We compared mortality, morbidity (including intraventricular haemorrhage, necrotising enterocolitis and chronic lung disease) and Griffiths General Quotient scores at 1-year corrected age. RESULTS There were 54 outborn and 519 inborn births in the gestational age range during the study period. Thirty-five (65%) outborn infants were transported to the NICU. Of the outborn infants, 21/54 (39%) survived to discharge compared with 375/519 (72%) inborn infants. For the 35 outborn infants transported to NICU, 14 (40%) died, compared with 6/35 (17%) of inborn infants. There were no differences in short-term and developmental outcomes in surviving infants. CONCLUSIONS Outborn extremely preterm infants <26 weeks gestation have higher mortality than inborn counterparts. However, those transported to a tertiary NICU have similar morbidity and developmental outcomes.
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Affiliation(s)
- Kirsten Thompson
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia.,Newborn Emergency Transport Service, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Jacqueline Gardiner
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Steven Resnick
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia.,Newborn Emergency Transport Service, Princess Margaret Hospital, Subiaco, Western Australia, Australia
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21
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Abstract
OBJECTIVE Pulse oximetry is used extensively in hospital and home settings to measure arterial oxygen saturation (SpO2). Interpretation of the trend and range of SpO2 values observed in infants is currently limited by a lack of reference ranges using current devices, and may be augmented by development of cumulative frequency (CF) reference-curves. This study aims to provide reference oxygen saturation values from a prospective longitudinal cohort of healthy infants. DESIGN Prospective longitudinal cohort study. SETTING Sleep-laboratory. PATIENTS 34 healthy term infants were enrolled, and studied at 2 weeks, 3, 6, 12 and 24 months of age (N=30, 25, 27, 26, 20, respectively). INTERVENTIONS Full overnight polysomnography, including 2 s averaging pulse oximetry (Masimo Radical). MAIN OUTCOME MEASUREMENTS Summary SpO2 statistics (mean, median, 5th and 10th percentiles) and SpO2 CF plots were calculated for each recording. CF reference-curves were then generated for each study age. Analyses were repeated with sleep-state stratifications and inclusion of manual artefact removal. RESULTS Median nocturnal SpO2 values ranged between 98% and 99% over the first 2 years of life and the CF reference-curves shift right by 1% between 2 weeks and 3 months. CF reference-curves did not change with manual artefact removal during sleep and did not vary between rapid eye movement (REM) and non-REM sleep. Manual artefact removal did significantly change summary statistics and CF reference-curves during wake. CONCLUSIONS SpO2 CF curves provide an intuitive visual tool for evaluating whether an individual's nocturnal SpO2 distribution falls within the range of healthy age-matched infants, thereby complementing summary statistics in the interpretation of extended oximetry recordings in infants.
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Affiliation(s)
- Philip Ian Terrill
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia
| | - Carolyn Dakin
- Department of Respiratory and Sleep Medicine, The Mater Children's Hospital, South Brisbane, Queensland, Australia
| | - Ian Hughes
- Australasian Paediatric Endocrine Group, Mater Medical Research Institute, Brisbane, Queensland, Australia
| | - Maggie Yuill
- Department of Respiratory and Sleep Medicine, The Mater Children's Hospital, South Brisbane, Queensland, Australia
| | - Chloe Parsley
- Department of Respiratory and Sleep Medicine, The Mater Children's Hospital, South Brisbane, Queensland, Australia
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22
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Rossor T, Greenough A. Advances in paediatric pulmonary vascular disease associated with bronchopulmonary dysplasia. Expert Rev Respir Med 2014; 9:35-43. [PMID: 25426585 DOI: 10.1586/17476348.2015.986470] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pulmonary hypertension (PH) is a common finding in infants with bronchopulmonary dysplasia (BPD). The aim of this review is to describe recent advances in the diagnosis and treatment of PH and discuss whether they will benefit infants and children with BPD related PH. Echocardiography remains the mainstay of diagnosis but has limitations, further developments in diagnostic techniques and identification of biomarkers are required. There are many potential therapies for PH associated with BPD. Inhaled nitric oxide has been shown to improve short term outcomes only. Sidenafil in resource limited settings was shown in three randomized trials to significantly reduce mortality. The efficacy of other therapies including prostacyclin, PDE3 inhibitors and endothelin receptor blockers has only been reported in case reports or case series. Randomized controlled trials with long term follow up are required to appropriately assess the efficacy of therapies aimed at improving the outcome of children with PH.
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Affiliation(s)
- Thomas Rossor
- Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, England, UK
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23
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Peter C, Boberski B, Bohnhorst B, Pirr S. Prescription of home oxygen therapy to very low birth weight infants in Germany: a nationwide survey. Clin Pediatr (Phila) 2014; 53:726-32. [PMID: 24671872 DOI: 10.1177/0009922814528037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is no consensus on prescription of home oxygen therapy to infants in Germany. We hypothesized that this causes considerable variability in prescribing home oxygen to infants. STUDY DESIGN A structured questionnaire involving management of home oxygen therapy was sent to all German pediatric departments (n = 293). RESULTS Response rate was 84% (247/293). SpO2 cutoff values below which oxygen therapy was considered indicated showed a wide range (80% to 94%, mean 90%). Respondents admitting >50 very low birth weight infants annually significantly more frequently prescribed home oxygen (P < .001) and aimed for SpO2 levels closer to the physiological range than those admitting less very low birth weight infants (P = .046). CONCLUSION Management of pediatric home oxygen therapy is diverse in Germany. Optimal SpO2 targets have to be further investigated by controlled studies and German guidelines should be established. Until then practice should abide by existing foreign guidelines.
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Abstract
Despite being the most widely used and vital therapy in neonatology, optimal strategies for the use of oxygen in preterm infants remain controversial. Achieving the balance between attaining adequate tissue oxygenation and avoiding oxygen toxicity is challenging. There remains a paucity of clear evidence based guidance for clinicians on safe oxygen saturation targets. What does seem apparent is that these targets vary over time in the life of a preterm infant. This article summarises the evidence behind current practice of oxygen monitoring and administration from the first few minutes after birth, through to the acute neonatal and later convalescent periods. Finally, we review the use of home oxygen for preterm infants with bronchopulmonary dysplasia including administration and weaning from domically home oxygen.
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25
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Lodha A, Sauvé R, Bhandari V, Tang S, Christianson H, Bhandari A, Amin H, Singhal N. Need for supplemental oxygen at discharge in infants with bronchopulmonary dysplasia is not associated with worse neurodevelopmental outcomes at 3 years corrected age. PLoS One 2014; 9:e90843. [PMID: 24646665 PMCID: PMC3960119 DOI: 10.1371/journal.pone.0090843] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/04/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To determine if chronic oxygen dependency (discharge home on supplemental oxygen) in children with bronchopulmonary dysplasia (BPD; defined as requirement for supplemental O2 at 36 weeks postmenstrual age) predicts neurodevelopmental disability rates and growth outcomes at 36 months corrected age (CA). STUDY DESIGN Longitudinal cohort study. SETTING Southern Alberta regional center located at high altitude. PARTICIPANTS Preterm infants weighing ≤1250 grams with no BPD, BPD, and BPD with chronic oxygen dependency. MAIN OUTCOME MEASURES Neurodevelopmental and growth outcomes. RESULTS Of 1563 preterm infants admitted from 1995-2007, 1212 survived. Complete follow-up data were available for 1030 (85%) children. Children in BPD and BPD with chronic oxygen dependency groups had significantly lower birth weights, gestational ages, prolonged mechanical ventilation and oxygen supplementation and received more postnatal steroids, compared to those without BPD. Children with BPD and BPD with chronic oxygen dependency were more likely to be below the 5th centile in weight and height compared to those without BPD but there was little difference between the BPD and BPD with chronic oxygen dependency groups. After controlling for confounding variables, children who had BPD and BPD with chronic oxygen dependency had higher odds of neurodevelopmental disability compared to those without BPD [OR (odds ratio) 1.9 (95%CI 1.1 to 3.5) and OR 1.8 (1.1 to 2.9), respectively], with no significant difference between BPD and BPD with chronic oxygen dependency [OR 0.9 (95% CI 0.6 to 1.5)]. CONCLUSIONS BPD and BPD with chronic oxygen dependency in children predicts abnormal neurodevelopmental outcomes at 36 months CA. However, the neurodevelopmental disability rates were not significantly higher in BPD with chronic oxygen dependency children compared to children with BPD only. Compared to those without BPD, growth is impaired in children with BPD and BPD with chronic oxygen dependency, but no difference between the latter two groups.
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Affiliation(s)
- Abhay Lodha
- Department of Pediatrics, Foothills Medical Centre, Peter Lougheed Centre, Alberta Children’s Hospital, Calgary, Canada
- Community Health Sciences, University of Calgary, Calgary, Canada
- Alberta Health Services, Calgary, Canada
- Alberta Children’s Hospital Institute of Child & Maternal Health, Calgary, Canada
| | - Reg Sauvé
- Department of Pediatrics, Foothills Medical Centre, Peter Lougheed Centre, Alberta Children’s Hospital, Calgary, Canada
- Community Health Sciences, University of Calgary, Calgary, Canada
- Alberta Health Services, Calgary, Canada
- Alberta Children’s Hospital Institute of Child & Maternal Health, Calgary, Canada
| | - Vineet Bhandari
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | | | - Heather Christianson
- Community Health Sciences, University of Calgary, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Anita Bhandari
- Department of Pediatric Pulmonology, Connecticut Children’s Medical Center, Hartford, Connecticut, United States of America
| | - Harish Amin
- Department of Pediatrics, Foothills Medical Centre, Peter Lougheed Centre, Alberta Children’s Hospital, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Nalini Singhal
- Department of Pediatrics, Foothills Medical Centre, Peter Lougheed Centre, Alberta Children’s Hospital, Calgary, Canada
- Alberta Health Services, Calgary, Canada
- Alberta Children’s Hospital Institute of Child & Maternal Health, Calgary, Canada
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26
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27
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Patient Safety in Pediatrics. PATIENT SAFETY 2014. [DOI: 10.1007/978-1-4614-7419-7_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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28
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Terrill PI, Wilson SJ, Suresh S, Cooper DM, Dakin C. Characterising non-linear dynamics in nocturnal breathing patterns of healthy infants using recurrence quantification analysis. Comput Biol Med 2013; 43:231-9. [PMID: 23399491 DOI: 10.1016/j.compbiomed.2013.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 01/07/2013] [Accepted: 01/11/2013] [Indexed: 11/25/2022]
Abstract
Breathing dynamics vary between infant sleep states, and are likely to exhibit non-linear behaviour. This study applied the non-linear analytical tool recurrence quantification analysis (RQA) to 400 breath interval periods of REM and N-REM sleep, and then using an overlapping moving window. The RQA variables were different between sleep states, with REM radius 150% greater than N-REM radius, and REM laminarity 79% greater than N-REM laminarity. RQA allowed the observation of temporal variations in non-linear breathing dynamics across a night's sleep at 30s resolution, and provides a basis for quantifying changes in complex breathing dynamics with physiology and pathology.
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Affiliation(s)
- Philip I Terrill
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland 4072, Australia.
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29
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Recommendations for long-term home oxygen therapy in children and adolescents. J Pediatr (Rio J) 2013; 89:6-17. [PMID: 23544805 DOI: 10.1016/j.jped.2013.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 08/08/2012] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To advise pediatricians, neonatologists, pulmonologists, pediatric pulmonologists, and other professionals in the area on the main indications and characteristics of long-term home oxygen therapy in children and adolescents. DATA SOURCE A literature search was carried out in the MEDLINE/PubMed database (1990 to 2011). Additionally, references from selected studies were included. As consistent scientific evidence does not exist for many aspects, some of the recommendations were based on clinical experience. DATA SYNTHESIS Long-term home oxygen therapy has been a growing practice in pediatric patients and is indicated in bronchopulmonary dysplasia, cystic fibrosis, bronchiolitis obliterans, interstitial lung diseases, and pulmonary hypertension, among others. The benefits are: decrease in hospitalizations, optimization of physical growth and neurological development, improvement of exercise tolerance and quality of sleep, and prevention of pulmonary hypertension/cor pulmonale. The levels of oxygen saturation indicative for oxygen therapy differ from those established for adults with chronic obstructive pulmonary disease, and vary according to age and disease. Pulse oximetry is used to evaluate oxygen saturation; arterial blood gas is unnecessary. There are three available sources of oxygen: gas cylinders, liquid oxygen, and oxygen concentrators. The flows used are usually smaller, as are the number of hours/day needed when compared to the use in adults. Some diseases show improvement and oxygen therapy discontinuation is possible. CONCLUSIONS Long-term home oxygen therapy is increasingly common in pediatrics and has many indications. There are relevant particularities when compared to its use in adults, regarding indications, directions for use, and monitoring.
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30
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Adde FV, Alvarez AE, Barbisan BN, Guimarães BR. Recommendations for long-term home oxygen therapy in children and adolescents. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ra JJ, Lee SM, Eun HS, Park MS, Park KI, Namgung R, Lee C. Risk Factors of Pulmonary Hypertension in Preterm Infants with Chronic Lung Disease. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.1.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jeong Jin Ra
- Division of Neonatology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Division of Neonatology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sun Eun
- Division of Neonatology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Division of Neonatology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Division of Neonatology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Division of Neonatology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Lee
- Division of Neonatology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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Terrill PI, Wilson SJ, Suresh S, Cooper DM, Dakin C. Application of recurrence quantification analysis to automatically estimate infant sleep states using a single channel of respiratory data. Med Biol Eng Comput 2012; 50:851-65. [PMID: 22614135 DOI: 10.1007/s11517-012-0918-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 04/23/2012] [Indexed: 11/28/2022]
Abstract
Previous work has identified that non-linear variables calculated from respiratory data vary between sleep states, and that variables derived from the non-linear analytical tool recurrence quantification analysis (RQA) are accurate infant sleep state discriminators. This study aims to apply these discriminators to automatically classify 30 s epochs of infant sleep as REM, non-REM and wake. Polysomnograms were obtained from 25 healthy infants at 2 weeks, 3, 6 and 12 months of age, and manually sleep staged as wake, REM and non-REM. Inter-breath interval data were extracted from the respiratory inductive plethysmograph, and RQA applied to calculate radius, determinism and laminarity. Time-series statistic and spectral analysis variables were also calculated. A nested cross-validation method was used to identify the optimal feature subset, and to train and evaluate a linear discriminant analysis-based classifier. The RQA features radius and laminarity and were reliably selected. Mean agreement was 79.7, 84.9, 84.0 and 79.2 % at 2 weeks, 3, 6 and 12 months, and the classifier performed better than a comparison classifier not including RQA variables. The performance of this sleep-staging tool compares favourably with inter-human agreement rates, and improves upon previous systems using only respiratory data. Applications include diagnostic screening and population-based sleep research.
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Affiliation(s)
- Philip I Terrill
- School of Information Technology and Electrical Engineering, The University of Queensland, St. Lucia, QLD, Australia.
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Vento M, Escobar J, Cernada M, Escrig R, Aguar M. The use and misuse of oxygen during the neonatal period. Clin Perinatol 2012; 39:165-76. [PMID: 22341544 DOI: 10.1016/j.clp.2011.12.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This article describes aerobic metabolism, oxygen free radicals, antioxidant defenses, oxidative stress, inflammatory response and redox signaling, the fetal to neonatal transition, arterial oxygen saturation, oxygen administration in the delivery room, oxygen during neonatal care in the NICU, evolving oxygen needs in the first few weeks of life, and complications that can occur when infants go home from the hospital on oxygen.
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Affiliation(s)
- Máximo Vento
- Division of Neonatology, University & Polytechnic Hospital La Fe, Bulevar Sur s/n, Valencia, Spain.
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McGrath-Morrow SA, Ryan T, McGinley BM, Okelo SO, Sterni LM, Collaco JM. Polysomnography in preterm infants and children with chronic lung disease. Pediatr Pulmonol 2012; 47:172-9. [PMID: 21815283 PMCID: PMC4751876 DOI: 10.1002/ppul.21522] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 06/12/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the utility of overnight polysomnography (PSG) in assessing pulmonary reserve in stable preterm children with chronic lung disease (CLD). STUDY DESIGN A retrospective review and descriptive study of overnight PSGs and clinic visits of preterm infants/children less than 3 years of age who were diagnosed with bronchopulmonary dysplasia at discharge from the hospital and enrolled in the Johns Hopkins CLD patient registry between 2008 and 2010. RESULTS Sixty-two clinically stable patients underwent at least one overnight polysomnogram for clinical indications. The majority of patients were referred for oxygen titration (71%). PSGs from first studies revealed a mean respiratory disturbance index (RDI) of 8.2 ± 10.1 events/hr and a mean O(2) saturation (SaO(2) ) nadir of 86.2 ± 5.7%. In patients who underwent more than one PSG (n = 23), a significant decrease in RDI (P < 0.001) was found between the first study (mean age: 8.0 ± 3.3 months) and second study (mean age: 13.4 ± 5.2 months). Outpatient clinical measures of mean room air SaO(2) and respiratory rate were not predictive of PSG measures of RDI and SaO(2) nadir. CONCLUSION Mean RDI was higher in stable preterm infants/children with CLD compared to previously published controls. RDI decreased with age in stable preterm infants/children with CLD suggesting improved pulmonary reserve with age. Outpatient clinical measures (respiratory rate and room air SaO(2) ) did not correlate with RDI and SaO(2) nadir indicating that overnight PSG is more sensitive in assessing pulmonary reserve than outpatient clinical measures.
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Affiliation(s)
- Sharon A McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287-2533, USA.
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Assessment of current strategies for weaning premature infants from supplemental oxygen in the outpatient setting. Adv Neonatal Care 2011; 11:349-56. [PMID: 22123406 DOI: 10.1097/anc.0b013e318229be3d] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE : With improvements in neonatal intensive care, more premature infants are surviving. Many have significant pulmonary morbidities after discharge from the hospital. Bronchopulmonary dysplasia is the most common morbidity of prematurity and is a common indication for home oxygen therapy in children. Data are lacking on the appropriate methods for weaning supplemental oxygen. The objective of this study was to identify the methods used by pediatric pulmonologists to wean premature infants from supplemental oxygen. SUBJECTS : One hundred eighty-four questionnaires were sent to pediatric pulmonologists at 20 pediatric pulmonary programs. DESIGN AND METHODS : This cross-sectional, self-administered anonymous survey assessed strategies for oxygen weaning for premature infants. MAIN OUTCOME MEASURES AND PRINCIPLERESULTS:: We had a 70% (14/20) institutional response rate. Of the responding institutions, we had a 73% (99/136) response rate. The majority of pulmonologists surveyed (78%) reported using nocturnal oxygen saturations as the primary indication for weaning. Only 8% of pulmonologists reported using a standardized protocol. Half of the respondents reported weaning diuretics prior to oxygen. The factors considered prior to initiating oxygen weaning included growth (96%), vital signs (85%), hospitalizations (68%), and echocardiograms (59%). Fewer respondents (21%) reported using chest x-ray findings. The minimum oxygen saturation in room air required to take a patient off oxygen ranged from 90% to 95%, with a mean of 93% (SD = 1.74). CONCLUSION : Pediatric pulmonologists reported a wide range of practice patterns in weaning premature infants from supplemental home oxygen. Very few respondents reported using a standardized protocol. There is no consensus about whether to wean diuretics or oxygen first. The majority of providers use nocturnal oxygen saturations as an indication for readiness to wean. Growth is an important factor for oxygen weaning considered by most pulmonologists surveyed. Consensus guidelines and subsequent evaluation of such guidelines are needed to ensure the safety of this growing population of infants.
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Kim GB. Pulmonary hypertension in infants with bronchopulmonary dysplasia. KOREAN JOURNAL OF PEDIATRICS 2010; 53:688-93. [PMID: 21189939 PMCID: PMC2994133 DOI: 10.3345/kjp.2010.53.6.688] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 05/13/2010] [Indexed: 11/27/2022]
Abstract
An increase in the number of preterm infants and a decrease in the gestational age at birth have resulted in an increase in the number of patients with significant bronchopulmonary dysplasia (BPD) and secondary pulmonary hypertension (PH). PH contributes significantly to the high morbidity and mortality in the BPD patients. Therefore, regular monitoring for PH by using echocardiography and B-type natriuretic peptide (BNP) or N-terminal-proBNP must be conducted in the BPD patients with greater than moderate degree to prevent PH and to ensure early treatment if PH is present. In the BPD patients with significant PH, multi-modality treatment, including treatment for correcting an underlying disease, oxygen supply, use of diverse selective pulmonary vasodilators (inhaled nitric oxide, inhaled prostacyclins, sildenafil, and endothelin-receptor antagonist) and other methods, is mandatory.
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Affiliation(s)
- Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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