When preterm infants with bronchopulmonary dysplasia (BPD) requiring home oxygen therapy in infancy, monthly follow-up visits are typically required as well as parent reports of the child’s respiratory. What if there was a way to record continuous home oximetry and transmit those readings to a neonatologist or pulmonologist between the monthly visits to speed up the weaning process? This idea came to fruition in the Recorded Home Oximetry (RHO) trial conducted by Rhein et al (10.1542/peds.2020-0079) and reported this month in our journal. The authors performed an unmasked randomized clinical trial in nine US medical centers from 2013 to 2017 with follow-up until 2019. The primary outcomes were the duration of home oxygen therapy and the overall parent-reported quality of life. Secondary outcomes included weight gain and any adverse events after discontinuing the home oxygen.
The good news is that of the 166 out of 196 infants who completed the trial, those who received the home monitoring oximetry device stopped home oxygen therapy an average of 78 days compared to 100 days in the standard treatment group. Sounds great, doesn’t it? However, after adjusting for severity of illness, the improvements were no longer statistically significant. In addition, quality of life did not differ between groups either. Does this mean monitoring of home oxygen therapy is not a good idea? It still is, according to an accompanying commentary by neonatologist Saran DeMauro from the Children’s Hospital of Philadelphia (10.1542/peds.2020-002774) who sees the work of Rhein et al as critical to gaining a better handle on questions such as what is the amount of oxygen to use at home, and whether home oxygen even makes a difference since other studies noted by Dr. DeMauro suggest outcomes in infants with BPD may be the same with or without home oxygen (reference 7 in commentary). Hopefully you’ll take some time at home to read this study and commentary and think about the benefits and risks of using home oxygen and accompanying oximetry transmission from home as a result of what you learn.