A statewide consensus for interpretation of continuous pulse oximetry data in chronic neonatal lung disease

Abstract

Background: Chronic Neonatal Lung Disease of Prematurity (CNLD) is the commonest complication of preterm birth, estimated to affect 30%-40% of very low birth weight infants. Low-flow supplemental oxygen facilitates discharge for these infants, supporting them until adequate lung growth and repair occurs. National Guidelines recommend the use of continuous oximetry to assess and manage oxygen therapy in these infants. However there are currently no National or International guidelines to guide interpretation of this data. At our centre specialist interpretation of infant oximetry is based on individual experience and opinion. Methods: Using a modified Delphi technique, paediatric respiratory and sleep medicine specialists were recruited to independently interpret 25 trend oximetry studies from de-identified preterm infants. They were provided a clinical vignette, an oximetry report and the following multiple choice responses: wean oxygen, remain in same oxygen, increase oxygen or repeat a technically poor study. Anonymous feedback on answers was provided to all respondents and a group discussion undertaken. Progress to Date: Nine specialists participated with 100% concordant answers on seven studies, 89% on four, 78% on eight, 67% on three, and 56% on three. Seven studies with discordant answers of both wean oxygen and increase oxygen were presented for group discussion and consensus answers were established for all 25 studies. A Statewide clinical guideline on supplemental oxygen therapy in CNLD has been published. Intended Outcome and Impact: There is limited evidence guiding how oxygen therapy should be utilised in preterm infants following hospital discharge and how different management may affect outcomes. In this study we achieved consensus amongst paediatric respiratory and sleep medicine specialists in how to interpret trend oximetry data in these infants and developed a Statewide management guideline to improve consistency of care. Future steps would be to assess longer term outcomes in these infants who have all been managed in a similar way, contributing to overall knowledge in this area.L6246120332018-11-01 <br />