How should babies with bronchopulmonary dysplasia receive oxygen therapy after discharge from hospital?

Author: Xu Lijuan, Li Yangyan Children's Hospital Affiliated to Chongqing Medical University

Reviewer: Wu Liping, Chief Nurse, Children's Hospital Affiliated to Chongqing Medical University

Bronchopulmonary dysplasia (BPD), also known as neonatal chronic lung disease (CLD), is an important cause of respiratory complications in premature newborns. Most BPD babies still need home oxygen therapy after discharge, and are prone to repeated lower respiratory tract infections, feeding difficulties, growth retardation and other problems, which seriously affect the prognosis and quality of life of the children. Therefore, for BPD babies who meet the discharge criteria, they often need a lot of supportive treatment after discharge, such as oxygen therapy, nutritional management and follow-up.

1. What preparations need to be made before discharge?

1. Prepare home oxygen therapy equipment

Including a portable oxygen concentrator (with humidification function), oxygen nasal cannula, and pulse oximeter.

Key points for using oxygen concentrators: ① The oxygen concentrator should be kept away from kitchens, fire sources and other flammable and explosive objects; ② It is strictly forbidden to apply oil to valves, switches and interfaces on the oxygen supply device; ③ Place it stably during use.

Key points for using oxygen nasal cannula: clean the oxygen tube and humidifier bottle every day; replace the oxygen tube every week; replace the humidified water every day to keep the tube unobstructed; it is recommended to choose an oxygen concentrator of 3L or above for newborns.

2. What should you pay attention to during home oxygen therapy?

1. Maintain appropriate blood oxygen saturation

Blood oxygen saturation should be maintained between 90% and 95%, 91% to 95% for babies under 36 weeks of gestation, and 93% to 95% during the recovery period of an illness. Continuously monitor blood oxygen saturation during breastfeeding and at night.

Currently, the most commonly used method of home oxygen inhalation is low-flow nasal cannula oxygen inhalation, which requires an oxygen flow rate of 0.5 to 1 L/min to avoid nasal mucosal damage and hypothermia caused by unheated and non-humidified high-flow gas.

2. Oxygen evacuation speed should not be too fast

Home oxygen therapy is beneficial to the growth and development of premature infants, but too fast oxygen withdrawal may reduce the growth rate of infants. Oxygen withdrawal should be gradual, and an individualized oxygen weaning plan should be developed.

In general, the total amount of oxygen inhalation is reduced first (i.e., the flow rate is lowered), and then the oxygen inhalation time is gradually shortened. It is best to try to stop oxygen for half an hour when the child is quiet and awake and has not fed milk. If there are no signs of hypoxia (i.e., no cyanosis of the lips, heart rate maintained within the normal range, and transcutaneous blood oxygen saturation can be maintained above 85%), then gradually extend the oxygen weaning time, and finally gradually withdraw when the child is breastfeeding. During the oxygen weaning period, the blood oxygen saturation should be maintained at 93% to 95%. The time when the blood oxygen saturation is lower than 85% shall not exceed 5% of the monitoring time (if the monitoring time is 60 minutes, then the time below 85% shall not exceed 3 minutes), and the time below 90% shall not exceed 10% of the monitoring time. In addition, attention should be paid to whether the baby has gastroesophageal reflux, because gastroesophageal reflux can also cause the baby to have temporary hypoxia.

3. Choose the right oxygen method

Figure 1 Copyright image, no permission to reprint

There are 4 oxygen supply methods to choose from: double-lumen nasal cannula oxygen supply, single-lumen nasal cannula oxygen supply, improved nasal cannula oxygen supply and paranasal cannula oxygen supply. When discharged from the hospital, choose the appropriate oxygen inhalation method according to the doctor's instructions. Under the same oxygen flow rate, the actual inhaled oxygen concentration of the baby is: double-lumen nasal cannula> single-lumen nasal cannula ≥ improved nasal cannula> paranasal cannula.

3. How to manage nutrition after discharge?

Ideal weight gain (20-30g per day) is the key to successful weaning of babies with BPD. Therefore, the caloric requirement of babies with BPD is 25% higher than that of babies without BPD, which can be as high as 140 kcal/(kg·d). Once successfully weaned, the caloric intake can be gradually reduced within 1 year after the baby is born.

For BPD babies who have feeding difficulties, it is necessary to choose appropriate feeding products based on the daily milk intake, such as breast milk + breast milk fortifier, premature infant formula, isocaloric whole protein formula, etc., and adjust the feeding method according to the baby's growth rate of weight, height, head circumference, etc.

Figure 2 Copyright image, no permission to reprint

4. Regular follow-up

Babies who are receiving home oxygen therapy should be followed up at the high-risk infant clinic every 2 to 4 weeks. A neonatologist, respiratory physician or pediatrician will objectively evaluate the baby's blood oxygen status based on the results of the continuous pulse oximeter test (at night or during the day), and evaluate the oxygenation status based on feeding, growth and activity tolerance, to guide the baby's treatment and oxygen reduction and suspension. Please prepare enough oxygen when going out!