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Title: | Respiratory management of infants with chronic neonatal lung disease beyond the NICU: A position statement from the Thoracic Society of Australia and New Zealand*. | Authors: | Kapur N.;Robinson P.;Massie J.;Prentice B.;Wilson A.;Schilling S.;Twiss J.;Fitzgerald D.A.;Nixon G. | Monash Health Department(s): | Paediatric - Respiratory and Sleep (Melbourne Children's Sleep Centre) | Institution: | (Kapur, Schilling) Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia (Kapur, Schilling) School of Medicine, University of Queensland, Brisbane, QLD, Australia (Nixon) Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia (Nixon) Department of Paediatrics, Monash University, Melbourne, VIC, Australia (Robinson) Respiratory and Sleep Medicine, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia (Robinson) Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia (Massie) Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, VIC, Australia (Prentice) Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, NSW, Australia (Wilson) Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia (Twiss) Respiratory Department, Starship Children's Hospital, Auckland, New Zealand (Fitzgerald) Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney and the Children's Hospital at Westmead, Sydney, NSW, Australia | Issue Date: | 23-Jul-2020 | Copyright year: | 2020 | Publisher: | Blackwell Publishing | Place of publication: | Australia | Publication information: | Respirology. 25 (8) (pp 880-888), 2020. Date of Publication: 01 Aug 2020. | Journal: | Respirology | Abstract: | Chronic neonatal lung disease (CNLD) is defined as continued need for any form of respiratory support (supplemental oxygen and/or assisted ventilation) beyond 36 weeks PMA. Low-flow supplemental oxygen facilitates discharge from hospital of infants with CNLD who are hypoxic in air and is widely used despite lack of evidence on the most appropriate minimum mean target oxygen saturations. Furthermore, there are minimal data to guide the home monitoring, titration or weaning of supplemental oxygen in these infants. The purpose of this position statement is to provide a guide for the respiratory management of infants with CNLD, with special emphasis on role and logistics of supplemental oxygen therapy beyond the NICU stay. Reflecting a variety of clinical practices and infant comorbidities (presence of pulmonary hypertension, retinopathy of prematurity and adequacy of growth), it is recommended that the minimum mean target range for SpO2 during overnight oximetry to be 93-95% with less than 5% of total recording time to be below 90% SpO2. Safety of short-term disconnection from supplemental oxygen should be assessed before discharge, with majority of infants with CNLD not ready for discharge until supplemental oxygen requirement is <=0.5 L/min. Sleep-time assessment of oxygenation with continuous overnight oximetry is recommended when weaning supplemental oxygen. Palivizumab is considered safe and effective for the reduction of hospital admissions with RSV infection in this group. This statement would be useful for paediatricians, neonatologists, respiratory and sleep physicians and general practitioners managing children with CNLD.Copyright © 2020 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/resp.13876 | PubMed URL: | 32510776 [http://www.ncbi.nlm.nih.gov/pubmed/?term=32510776] | ISSN: | 1323-7799 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/29195 | Type: | Article | Subjects: | oxygen saturation oxygen therapy oxygenation pathophysiology pulmonary hypertension respiratory syncytial virus infection retrolental fibroplasia sleep time treatment indication caffeine/ct caffeine diuretic agent/ct diuretic agent oxygen palivizumab/ct palivizumab palivizumab/im [Intramuscular Drug Administration] chronic neonatal lung disease oximetry assisted ventilation Australia and New Zealand chronic lung disease clinical practice hospital admission infant lung dysplasia medical neonatal intensive care unit newborn apnea newborn disease |
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