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Assessment of Current Strategies for Weaning Premature Infants From Supplemental Oxygen in the Outpatient Setting

Palm, Kara MD; Simoneau, Tregony MD; Sawicki, Gregory MD, MPH; Rhein, Lawrence MD

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0b013e318229be3d
Original Research

PURPOSE: With improvements in neonatal intensive care, more premature infants are surviving. Many have significant pulmonary morbidities after discharge from the hospital. Bronchopulmonary dysplasia is the most common morbidity of prematurity and is a common indication for home oxygen therapy in children. Data are lacking on the appropriate methods for weaning supplemental oxygen. The objective of this study was to identify the methods used by pediatric pulmonologists to wean premature infants from supplemental oxygen.

SUBJECTS: One hundred eighty-four questionnaires were sent to pediatric pulmonologists at 20 pediatric pulmonary programs.

DESIGN AND METHODS: This cross-sectional, self-administered anonymous survey assessed strategies for oxygen weaning for premature infants.

MAIN OUTCOME MEASURES AND PRINCIPLERESULTS: We had a 70% (14/20) institutional response rate. Of the responding institutions, we had a 73% (99/136) response rate. The majority of pulmonologists surveyed (78%) reported using nocturnal oxygen saturations as the primary indication for weaning. Only 8% of pulmonologists reported using a standardized protocol. Half of the respondents reported weaning diuretics prior to oxygen. The factors considered prior to initiating oxygen weaning included growth (96%), vital signs (85%), hospitalizations (68%), and echocardiograms (59%). Fewer respondents (21%) reported using chest x-ray findings. The minimum oxygen saturation in room air required to take a patient off oxygen ranged from 90% to 95%, with a mean of 93% (SD = 1.74).

CONCLUSION: Pediatric pulmonologists reported a wide range of practice patterns in weaning premature infants from supplemental home oxygen. Very few respondents reported using a standardized protocol. There is no consensus about whether to wean diuretics or oxygen first. The majority of providers use nocturnal oxygen saturations as an indication for readiness to wean. Growth is an important factor for oxygen weaning considered by most pulmonologists surveyed. Consensus guidelines and subsequent evaluation of such guidelines are needed to ensure the safety of this growing population of infants.

Department of Pulmonary Medicine, Children's Hospital Boston, Boston, Massachusetts.

Correspondence: Tregony C. Simoneau, MD, Pediatric Pulmonary Fellow, Childrens Hospital Boston, Division of Pulmonary Medicine, Department of Medicine, 300 Longwood Ave, Boston, MA 02115 (Tregony.simoneau@childrens.harvard.edu).

Kara Palm, MD, and Tregony Simoneau, MD, are co-first authors.

The authors declare that they have no competing interests to disclose.

© 2011 National Association of Neonatal Nurses