74 Variability on decision to discontinue supplemental oxygen among Canadian Pediatric respirologists in premature patients with BPD: A cross sectional survey study

Approximately 8% of all Canadian births are preterm and one of the most common pulmonary complications associated with prematurity is bronchopulmonary dysplasia (BPD) which is defined as the persistent need for oxygen at 36 weeks post menstrual age or 28 days of postnatal life. Close to half of all premature infants with BPD are discharged from hospital with home oxygen and Pediatric respirologists are commonly involved in the decision of discontinuing home oxygen use after the newborn period. Our aim was to assess whether there is variability among Canadian pediatric respirologists on when to discontinue supplemental oxygen and given the lack of evidence based guidelines we hypothesize that there will be variability in this decision making process. Gathering data on current practices in Canada can help fuel quality improvement projects to help improve standardization and clinical practice guidelines specific to the Canadian population of premature infants with BPD. A cross sectional survey study was completed and anonymous surveys were distributed in both English and French through the Cross Canada respiratory rounds list serve and the Canadian Respiratory conference 2018. Surveys included four oximetry test interpretations, 8 follow up questions on the decision making process and 4 questions on physician demographics. Ethics approval was obtained through the Research and Ethics Board prior to data collection. The survey response rate was 27%. There were responses from 6 provinces, 71% reported having more than 15 patients who required home oxygen use in their practice and 63% had practiced in the field for at least 5 years. The decision to discontinue home oxygen varied amongst Canadian Pediatric respirologists with 29% in favor of discontinuing home oxygen using the 4 provided oximetry tests to 71% against the decision. The decision to discontinue home oxygen did vary based on the province of current work; Alberta had a highest rate of respondents choosing to discontinue home oxygen (47.5%) in comparison to British Columbia and Quebec (18% and 20% respectively). Respirologists who completed their fellowship training in Canada were more likely to discontinue home oxygen compared to respondents who trained in the United States (31% vs 25%). The presence of pulmonary hypertension was rated as being the highest likelihood in affecting the decision to discontinue home oxygen (97%). Close to half of the respondents (42%) reported not being aware of any existing guidelines on supplemental oxygen use and amongst the respondents who did use a guideline, 72% reported using the British Thoracic Society guidelines for home oxygen use in children. This project allowed us to gather data on current practices on home oxygen use decision making amongst Canadian respirologists and informs that there is variability on care that patients receive across the country based on the experience and training of the pediatric respirologists.