Domiciliary oxygen therapy in children

Domiciliary oxygen therapy in children should be prescribed and managed by a specialist.

Domiciliary oxygen therapy is recommended for children with severe chronic hypoxaemia who are unable to maintain oxygen saturation measured by pulse oximetry (SpO₂) at 93% or greater on room air (although children with cyanotic congenital heart disease usually have lower target oxygen saturation levels, as determined by their treating specialists).

The largest group of children with severe chronic hypoxaemia are infants with chronic neonatal lung disease, which is a sequela to severe hyaline membrane disease (caused by a deficiency of pulmonary surfactant). The terms chronic neonatal lung disease, chronic lung disease of prematurity and bronchopulmonary dysplasia are used interchangeably in practice. Domiciliary oxygen in these children aims to maintain SpO₂ in a minimum mean target range of 93 to 95%. Treatment also aims to avoid SpO₂ falling below 90% for more than 5% of the total recording time, as measured by overnight pulse oximetry; prolonged SpO₂ below 90% has been associated with adverse clinical outcomes. A lower target oxygen saturation may be used in children with cyanotic congenital heart disease.

Most infants needing domiciliary oxygen therapy require a low flow of oxygen, between 0.125 and 0.5 litres per minute. Oxygen is usually delivered through an oxygen concentrator via a low-flow meter, lightweight plastic tubing and nasal cannulae. Small cylinders can be used for portability.

All infants born prematurely with oxygen-dependent chronic lung disease should be monitored by a respiratory paediatrician every 4 to 6 weeks following discharge from the neonatal unit. Feeding, weight gain and SpO₂ (measured at the time of clinic visits) are used to determine the rate of weaning from oxygen treatment.

Oxygen desaturation during sleep continues for longer than daytime desaturation in these infants, particularly during rapid eye movement (REM) sleep. Before stopping therapy, it is essential that continuous overnight pulse oximetry without supplemental oxygen shows a minimum mean SpO₂ of 93 to 95%. Temporary reintroduction of low-flow oxygen may be required if the infant develops respiratory illness in the months after stopping oxygen therapy.