Clinician perspectives of oxygen control in children with bronchopulmonary dysplasia at home: an international survey of clinicians from 44 countries

Background: Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth and may lead to difficulties with oxygen control even at home. How oxygenation is managed outside the hospital and in high and low resourced settings is unclear. Aims: To determine clinician perspectives for managing oxygenation after hospital discharge in infants with BPD. Methods: An opportunistic, anonymous, online survey was developed in English and translated into Mandarin, Vietnamese and Korean. The survey was disseminated three times to neonatal clinicians between December 2022 and August 2023. Responses were classified using the World Bank Income Classification. Results: Overall, 610 clinicians from 44 countries responded, with 453 (74%, 453/610) from high- and upper-middle-income countries (HMIC) and 153 (25%, 153/610) from low- and lower-middle-income countries (LMIC). Most clinicians (84%, 510/610) would advocate discharge on home oxygen therapy (HOT), but this was less possible in LMIC (65% vs. 91%, p < 0.001). Most clinicians perceived HOT to improve growth (73%, 370/510) and neurodevelopment (72%, 366/510). HMIC respondents were more likely to use home oximetry (78% vs. LMIC 67%, p = 0.012). There were wide variations in oxygen saturation targets, pre-discharge oximetry use, and parameters for weaning. Most clinicians perceived novel technologies such as wearable oximetry with parent-led oxygen control as important (77%, 460/596) and useful (84%, 499/595) for improving oxygen management at home. Conclusion: Most neonatal clinicians would prescribe HOT for infants with BPD but are limited by barriers to sufficient resourcing, especially in LMIC. Evaluation of cost-effective novel monitoring techniques may improve accessibility and control of HOT.