654 Are rates of bronchopulmonary dysplasia explained by variation in clinicians’ approach to assessment of the need for supplemental oxygen?

Abstract

<h3>Aims</h3> <b>Background –</b> Variation in rates of bronchopulmonary dysplasia (BPD) across the UK is not explained by known confounders. Differences in diagnostic criteria may contribute to this variation. <b>Objectives -</b> To describe selection criteria used by clinicians to instruct formal assessment of the need for supplemental oxygen at discharge from the neonatal unit (NNU) in addition to interpretation of pulse oximetry studies (POS), and to compare differences in practice with reported rates of BPD. <h3>Methods</h3> Nationwide survey of UK neonatal units (NNUs), June 2020 to January 2021. <h3>Results</h3> Responses were received from 112/173 (64.7%) NNUs. There was variation in both criteria used to select infants for assessment, and criteria used to interpret pulse oximetry studies. 76.7% of respondents routinely assessed the need for supplemental oxygen in ex-preterm infants requiring respiratory support and/or oxygen at ³ 36 weeks’ post menstrual age and for at least 28 days; 9.2% routinely assessed infants requiring respiratory support and/or oxygen for 28 days only; 4.2% routinely investigated all infants below a specified gestation and 24.2% assessed all ex-preterm infants requiring support within a certain time period prior to discharge. There was no clear relationship between selection criteria and reported rates of BPD. Criteria used to define as normal an extended POS undertaken in room air also varied widely between respondents. The most commonly used criterion was time spent below a defined lower oxygen saturation threshold which ranged from &lt;2-£10% of the recording; where the lower oxygen saturation threshold was specified, the value ranged from 80 – 96%. There was no clear association between criteria used to interpret oxygen saturation monitoring and BPD rates. <h3>Conclusion</h3> Variation in assessment of the need for supplemental oxygen in ex-preterm infants ready for discharge exists across the UK, both between and within NNUs, with potential implications for provision of home oxygen. Further research into the clinical characteristics of preterm infants who warrant formal assessment and optimal thresholds for commencing supplemental oxygen are needed to inform and standardise practice.