Transmitted Home Oximetry and Duration of Home Oxygen in Premature Infants

• DOI: 10.1542/peds.2020-0079
• Publication Date: 2020-07-14T13:47:08Z
• Authors: Lawrence Rhein; Heather White; Tregony Simoneau; Nadav Traeger; Thomas Lahiri; Ted Kremer; Catherine Sheils; Kathleen Meyer; Ted Rosenkrantz; Sankaran Krishnan; Tyler Hartman; Henry A. Feldman; Elie G. Abu Jawdeh
• Keywords: Male; Body Weight; Infant, Newborn; Oxygen Inhalation Therapy; Infant; Home Care Services, Hospital-Based; Pediatrics; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Medicine and Health Sciences; Quality of Life; Humans; Multicenter Studies as Topic; Female; Oximetry; Infant, Premature; Bronchopulmonary Dysplasia; Randomized Controlled Trials as Topic

OBJECTIVES: To determine if a home oxygen therapy (HOT) management strategy that includes analysis of recorded home oximetry (RHO) data, compared with standard monthly clinic visit assessments, reduces duration of HOT without harm in premature infants.

METHODS: The RHO trial was an unmasked randomized clinical trial conducted in 9 US medical centers from November 2013 to December 2017, with follow-up to February 2019. Preterm infants with birth gestation ≤37 + 0/7 weeks, discharged on HOT, and attending their first pulmonary visit were enrolled. The intervention was an analysis of transmitted RHO between clinic visits (n = 97); the standard-care group received monthly clinic visits with in-clinic weaning attempts (n = 99). The primary outcomes were the duration of HOT and parent-reported quality of life. There were 2 prespecified secondary safety outcomes: change in weight and adverse events within 6 months of HOT discontinuation.

RESULTS: Among 196 randomly assigned infants (mean birth gestational age: 26.9 weeks; SD: 2.6 weeks; 37.8% female), 166 (84.7%) completed the trial. In the RHO group, the mean time to discontinue HOT was 78.1 days (SE: 6.4), compared with 100.1 days (SE: 8.0) in the standard-care group (P = .03). The quality-of-life scores improved from baseline to 3 months after discontinuation of HOT in both groups (P = .002), but the degree of improvement did not differ significantly between groups (P = .75).

CONCLUSIONS: RHO was effective in reducing the duration of HOT in premature infants. Parent quality of life improved after discontinuation. RHO allows physicians to determine which infants can be weaned and which need prolonged oxygen therapy between monthly visits.