• To put an effective plan in place to allow oxygen-dependent babies to be cared for safely at home

   

• Chronic lung disease with ongoing demand for additional inspired oxygen [see British Thoracic Society (BTS) guidance]

Criteria

• Clinically stable on oxygen therapy via nasal cannulae for ≥2 weeks
• SpO₂ ≥93% after 36 weeks’ gestation on <0.5 L/min oxygen (if ≥0.5 L/min oxygen requirement at term then refer to paediatric respiratory team)
• Cyanotic congenital heart disease: a lower value may be appropriate, set threshold on an individual basis (liaise with paediatric cardiologists)
• Overnight pulse oximetry study when on stable oxygen for 1 week before discharge (see BTS guidelines): 
  
  • mean SpO₂ ≥93% without frequent periods of desaturations
  • SpO₂ ≥90% for >95% of the artefact-free recording period
• If using <0.5 L/min ensure baby able to cope with short periods in air in case nasal cannulae become dislodged
• Routine continuous oxygen monitoring discontinued 
• Thermo-control well established
• Feeding orally 3–4 hrly and gaining weight 
  
  • some babies may require tube feeding, if all other criteria are met, this should not hinder discharge 
• Final decision on suitability for discharge lies with consultant

Make arrangements with parents

• Discuss need for home oxygen with parents

• Obtain consent for home oxygen supply and for sharing information with oxygen supplier. This is obligatory before supplier can be contacted with patient details

• Arrange multidisciplinary meeting 1 week before discharge with parents/carers, community nurse, health visitor and member of NNU

• Car seat challenge

• Arrange discharge plan (see Discharge from neonatal unit guideline)(see Discharge from neonatal unit guideline)

Parent training

• Resuscitation techniques (2 adults)
• No smoking in the house or anywhere in baby’s environment 
• Recognition of baby’s breathing pattern, colour and movements
• Use of oxygen equipment (2 adults)
• Competence in tape application for nasal prongs and skin care (water-based emollients)
• What to do in case of emergency:
  
  • contact numbers 
  • direct admission policy
  • fire safety and insurance advice (car and home)
• Discuss DLA/blue badge advantage

Organise oxygen

• Prescribing clinician to complete Home Oxygen Order Form (HOOF) on OxyShop www.oxyshop.org
• Do not send home on <0.1 L (even if on <0.1 L in NNU. See BTS guidelines). Aim for early overnight oximetry (4 weeks) to ascertain if baby still requires oxygen

Discharge checklist

• Discharge plan implemented (see Discharge from neonatal unit guideline)
• Plan discharge for beginning of week to ensure community staff available in event of problems at home
• Oxygen supply and equipment installed in the home 
• Baby will go home on prescribed amount of oxygen; this may be altered on direction of medical or nursing staff, or in event of emergency 
• GP and other relevant professionals (also fire and electricity companies, although oxygen supplier usually does this) informed of date and time of discharge
• Community team briefed to arrange home visit well in advance of discharge to ensure conditions suitable and equipment correctly installed
• Parents/carers trained to care for baby safely at home and have support contact numbers
• Open access to paediatric ward 

• As oxygen-dependent babies (e.g. chronic lung disease) are at increased risk of contracting respiratory syncytial virus (RSV), give palivizumab and influenza vaccine (see Immunisations and Palivizumab guidelines)
• Refer to local guidelines for follow-up