Background Currently there are no evidence based guidelines to standardise the process of weaning home oxygen therapy in infants with chronic lung disease of prematurity (CLDP). Weaning decisions are based on interpretation of overnight oxygen saturation tracings and clinical assessment by the clinician delivering follow-up care.

Aims The primary aim was to complete a service evaluation of how preterm infants were weaned from home oxygen and compare this with recommendations in literature. The secondary aim was to collect and analyse data from saturation tracings and a questionnaire survey of clinicians, with the aim of devising a suitable local guideline to standardise practice.

Methods A retrospective (2008–2012) case note review of 26 patients discharged on home oxygen therapy was performed. An online questionnaire was sent to eight neonatal consultants from one hospital to study current practice. 2 ×  2 diagnostic tests were performed on data collected from 104 saturation tracings to identify suitable variables for weaning.

Results The questionnaire response rate was 75% and revealed variation in weaning frequency and saturation levels used (most commonly 94%) when analysing saturation tracings. Together with observational data, this also highlighted incomplete documentation of reports. Diagnostic testing identified low sensitivity (60% and 38.5%) and high specificity (100%) when mean and median SpO₂ ≥95% were considered alongside the saturation cut off level. When dips in saturation were considered, using ≤30 dips for weaning had a sensitivity of 82.9% and specificity of 84.8%.

Conclusion Weaning can be based on the percentage time spent under a certain saturation cut-off (most commonly 94%). Mean or median SpO₂ ≥95% and ≤30 dips below 90% are useful adjuncts when weaning. Care could be improved by standardising weaning, improving documentation of reports and maintaining a prospective database documenting changes made to therapy.

References

1. Balfour-Lynn, I. M., et al. “BTS guidelines for home oxygen in children.” Thorax 64. Suppl 2 (2009): ii1-ii26.

2. MacLean, J.E., Fitzgerald, D.A. (2006). A rational approach to home oxygen use in infants and children. Paediatric respiratory reviews, 7:215–222.