Weight-based oxygen flow rate is predictive of successful weaning of long-term oxygen therapy in babies with bronchopulmonary dysplasia

Abstract

Background: There are currently no evidence-based guidelines to wean home oxygen in babies with bronchopulmonary dysplasia(BPD). We perform serial overnight oximetry guiding a wean to a reduced flow rate until discontinuation if babies meet set targets(wean by decrements of 0.1L/min until a flow rate of 0.1L/min is achieved→ 2 hour day time oximetry in air→ increasing awake time off oxygen over 2 weeks→ overnight air study→ discontinue). Previous small studies suggest that flow rates of ≤20 ml/kg/min are predictive of successful oxygen discontinuation. Aims: To evaluate the pre-weaning weight-based flow rates of babies successfully weaned from oxygen. Methods: 173 babies were successfully weaned from home oxygen for BPD. The weight of the child at time of oxygen discontinuation was recorded. Babies without a recorded weight were excluded (n=24). Flow rates for each baby immediately prior to coming off oxygen were calculated in ml/kg/min. Results: This analysis includes 5 babies who were successfully weaned from a flow rate of ≤20 ml/kg/min i.e. weaned from an absolute flow rate of ≥0.1 L/min, or who had day and night air studies carried out on the same day, thereby reducing the duration of home oxygen therapy. Conclusions:Successful weaning from home oxygen in a large cohort of babies with BPD is associated with pre-weaning flow rates of ≤20 ml/kg/min. This validates previous suggestions that this may be a useful predictor of readiness to come off oxygen.