Care of Babies on Oxygen At Home Following Discharge From NICU
 

 

Reviewed by David McNamara, Simon Rowley, Jacob Twiss and Marion Jones

September 2010
Clinical Guidelines Back Newborn Services Home Page
 
Oxygen Saturation Targets Before Referral Referral
Request for Oxygen Follow up & weaning Flying when on Oxygen
 

At risk babies should have an overnight saturation run prior to discharge.

Oxygen Saturation Targets

Parameter Target1,2
Mean SpO2 93%
% time less than 90% <5% of artefact free recording
Desaturations Not excessive

The targets above are for infants with chronic neonatal lung disease based on the available literature and guidelines. The median baseline saturation in healthy term infants during the first year of life is 97-98% however there is no evidence of benefit targeting these normal levels with oxygen therapy.

Infants who do not meet these minimum targets while breathing air but are otherwise ready for discharge should be considered for home oxygen therapy.

Before referral for home oxygen

Infants suitable for home oxygen therapy will:

The Starship Paediatric Respiratory Service recommends a higher target (95%) in the context of pulmonary hypertension and infants should have clinical and ECG screening for this prior to discharge.

A relevant (generally recent) chest x-ray and capillary blood gas are useful investigations prior to discharge. Hypercarbia is associated with increased risk of hospital readmission3.

An ‘air challenge’, whereby the effects and safety of short-term oxygen disconnection is assessed is advisable. There is no evidence based protocol for this however the British Thoracic Society suggest a minimum SpO2 of ≥ 80% is maintained for 30 minutes off oxygen before discharge2.

Referral to the Respiratory Service

Referral to the Starship Respiratory Service for formal review should be considered in any of the following contexts:

It is more appropriate to refer these babies to Paediatric Homecare from the outset rather than Neonatal Homecare.

Request for home oxygen

Follow up, weaning and discontinuation of home oxygen

Flying - when on oxygen and after oxygen has been discontinued.

The oxygen content inside aeroplanes flying at altitude is significantly less than at sea level (~15% vs 21% oxygen). This is not an issue for most healthy children but children on oxygen therapy will likely need more oxygen and those who have recently discontinued their oxygen may need to go back on it for the flight.

The rules, provisions and costs vary between airlines and it is worth shopping around. It is important to advise the airline well ahead of time. Generally flows of 2-4 l/min are available, usually much higher than the infant is usually on or strictly will need.

In infants where the need or prescription for in flight oxygen is unclear, the Respiratory Physiology Laboratory at Starship Childrens can do a test where cabin air conditions are simulated (15% oxygen) while oximetry is measured and oxygen (if needed) titrated. The British Thoracic Society recommends this test for infants flying within six months of discontinuing oxygen therapy.

References

1 Fitzgerald DA et al, TSANZ position statement: Infants with chronic neonatal lung disease: recommendations for the use of the home oxygen therapy, MJA 2008; 189(10):578-582.
2 Balfour-Lynn IM et al, BTS guidelines for home oxygen in children, Thorax 2009;64(suppl II):ii1-ii26.
3 Kovesi T et al, Elevated Carbon Dioxide Tension as a Predictor of Subsequent Adverse Events in Infants with Bronchopulmonary Dysplasia, Lung 2006; 184:7-13.