Oxygen therapy and home oxygen in children — structured clinical encounter

Structured encounter following an ex-preterm infant with chronic lung disease of prematurity from a hospital oxygen requirement to a home oxygen programme and its weaning: setting the saturation target, choosing the device, recognising the readiness criteria for home oxygen, arranging the equipment and safety, planning the weaning day then sleep then off, and counselling the family, with the acute principles of the hypoxaemic child woven through.

structured clinical encounter2 min readVerification in progress

Prompt

A former twenty-five-week infant with chronic lung disease of prematurity is medically stable but still needs a low flow of nasal cannula oxygen to hold saturations in the target band, particularly during sleep and feeding. She is feeding and gaining weight. You are the paediatric registrar planning her transition to a home oxygen programme and its eventual weaning.

Station 1 — setting the target and the device

Asked how I decide her oxygen, I explain that oxygen is a drug titrated to a prescribed saturation target band rather than to the highest number, and that for an infant with chronic lung disease the band is set to protect growth and the pulmonary circulation while avoiding hyperoxia. A nasal cannula at a low flow is the right device because it is comfortable and lets her feed, and I titrate the flow to keep her in the band, watching especially during sleep and feeding when saturations dip lowest. [1] [3]

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References11Show ledger

[1]Hayes D Jr; Wilson KC; Krivchenia K; et al Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med, 2019.PMID 30707039
[2]Balfour-Lynn IM; Field DJ; Gringras P; et al BTS guidelines for home oxygen in children. Thorax, 2009.PMID 19586968
[3]O'Driscoll BR; Howard LS; Earis J; et al BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax, 2017.PMID 28507176
[4]Cunningham S; Rodriguez A; Adams T; et al Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet, 2015.PMID 26382998
[5]Franklin D; Babl FE; Schlapbach LJ; et al A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med, 2018.PMID 29562151
[6]Rojas-Reyes MX; Granados Rugeles C; Charry-Anzola LP Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age. Cochrane Database Syst Rev, 2014.PMID 25493690
[7]Askie LM; Darlow BA; Finer N; et al Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration. JAMA, 2018.PMID 29872859
[8]Manja V; Lakshminrusimha S; Cook DJ Oxygen saturation target range for extremely preterm infants: a systematic review and meta-analysis. JAMA Pediatr, 2015.PMID 25664703
[9]Saugstad OD; Aune D Optimal oxygenation of extremely low birth weight infants: a meta-analysis and systematic review of the oxygen saturation target studies. Neonatology, 2014.PMID 24247112
[10]Graham HR; King C; Duke T; et al Hypoxaemia and risk of death among children: rethinking oxygen saturation, risk-stratification, and the role of pulse oximetry in primary care. Lancet Glob Health, 2024.PMID 38914087
[11]Franklin D; Babl FE; Neutze J; et al Predictors of Intensive Care Admission in Hypoxemic Bronchiolitis Infants, Secondary Analysis of a Randomized Trial. J Pediatr, 2023.PMID 36528052