Global Perspectives on Home Oxygen Therapy for Infants with Bronchopulmonary Dysplasia 🌎🫁👶

https://www.youtube.com/watch?v=YqqERqqOyRE

New International Survey Highlights Variations in Oxygen Management Around the World

Bronchopulmonary dysplasia (BPD) remains one of the most common complications of extreme prematurity. Many infants with BPD require supplemental oxygen beyond their initial hospital stay, yet there is surprisingly little consensus on how oxygen therapy should be managed after discharge home.

A new international survey involving clinicians from 44 countries provides valuable insight into current practices, challenges, and opportunities for improving oxygen management for infants with BPD living at home.

Why Is Oxygen Management Important?

Infants with BPD often experience ongoing respiratory instability after discharge from the NICU. Maintaining adequate oxygen levels is essential because episodes of hypoxemia may contribute to:

• Poor growth

• Pulmonary hypertension

• Neurodevelopmental impairment

• Increased hospital readmissions

• Mortality

At the same time, excessive oxygen exposure may also be harmful. Finding the right balance remains one of the major challenges in neonatal follow-up care.

An International Collaboration

To better understand how clinicians manage oxygen therapy at home, investigators conducted an international survey involving neonatal clinicians, pediatricians, respiratory physicians, and pulmonary hypertension specialists.

The survey collected 610 responses from 44 countries, including both high-resource and low-resource healthcare settings. Clinicians from Australia, New Zealand, Canada, the United States, Europe, Asia, Africa, and South America contributed their perspectives.

What Did the Survey Find?

Most Clinicians Support Home Oxygen Therapy

Overall, 84% of clinicians reported that they would discharge infants with BPD on home oxygen therapy when appropriate.

Clinicians believed home oxygen therapy improves:

• Growth

• Neurodevelopment

• Respiratory health

• Feeding

• Sleep quality

However, access to home oxygen therapy varied significantly between countries. Clinicians practicing in low- and lower-middle-income countries were substantially less likely to have access to home oxygen programs than those practicing in higher-income settings.

Wide Variation in Oxygen Targets

One of the most striking findings was the lack of agreement regarding oxygen saturation targets.

Clinicians reported average oxygen saturation goals ranging from:

• Below 85%

• 85–89%

• 90–92%

• 93–95%

• Above 95%

The most commonly used target range was 93–95%, but substantial variation existed between countries and healthcare systems.

Different Approaches to Monitoring

Most clinicians used pulse oximetry before discharge to determine whether an infant required home oxygen.

After discharge, monitoring practices varied considerably:

• Overnight oximetry

• Spot oximetry assessments

• Home pulse oximetry downloads

• Telehealth reviews

• Clinical assessment alone

• Parent-reported oxygen readings

Clinicians in lower-resource settings were less likely to have access to advanced monitoring technologies.

The Promise of New Technologies

A particularly encouraging finding was the strong support for innovative monitoring technologies.

Most clinicians felt that wearable oxygen monitoring systems could help improve care by:

• Increasing accessibility

• Supporting families at home

• Allowing earlier detection of problems

• Facilitating oxygen adjustments

• Reducing unnecessary hospital visits

More than three-quarters of respondents believed wearable home oximetry systems would be acceptable and useful in clinical practice.

Why This Study Matters

This survey highlights an important reality: while clinicians around the world agree that optimizing oxygen therapy is critical for infants with BPD, there remains substantial variation in practice.

The findings emphasize the need for:

• Better evidence regarding optimal oxygen saturation targets

• International consensus guidelines

• More accessible home monitoring technologies

• Improved support for families caring for infants with BPD

• Greater equity in access to home oxygen programs worldwide

As neonatal care continues to improve, more infants survive extreme prematurity than ever before. Ensuring safe and effective oxygen management after discharge represents an important next step in improving long-term outcomes for these vulnerable infants.

Looking Ahead

This international collaboration demonstrates the growing interest in leveraging technology and global partnerships to improve neonatal care beyond the NICU.

Future research will focus on developing evidence-based oxygen targets, evaluating wearable monitoring systems, and identifying strategies that can improve oxygen management for infants with BPD regardless of where they live.

Every infant deserves the opportunity to thrive—not only in the NICU, but also after going home.

https://onlinelibrary.wiley.com/doi/10.1111/jpc.70458