Domiciliary Non-Invasive Ventilation (NIV) program in children: a pilot project

<bold>Background:</bold> The use of long-term noninvasive ventilation (NIV) in children has become increasingly prevalent in recent years. Traditional follow-up methods typically involve repeated hospitalizations for overnight sleep exams. However, in-built software data and domiciliary nocturnal capnography could present a novel approach to follow-up. <bold>Aims and Objectives:</bold> This study aimed to assess the feasibility and effectiveness of a domiciliary NIV program for children in the Italian Friuli Venezia Giulia region. <bold>Methods:</bold> All pediatric patients on home NIV for more than 2 months were prospectively enrolled in the study. <bold>Results:</bold> Between June 2021 and September 2023, 30 subjects (median age: 14.9 months; 21 males) were included. Most patients had neuromuscular diseases (66.7%), with spinal muscular atrophy (SMA) being the most common diagnosis (10 patients). All enrolled subjects received at least one home visit, with 70% receiving at least two visits. A total of 97 visits were conducted, including 91 overnight capnography. Recordings had good quality in 83.5% of cases. Abnormalities were observed in 52.6% of exams, PCO2 >50 mmHg for ≥2% of recording time in 35.2%, mean PCO2 <35 mmHg in 21.6%, mean SpO2 <90% for ≥2% of recording time in 11.8%, or a combination of PCO2 and SpO2 alterations in 31.4%. Ventilatory parameters were changed in 15.6% of cases. Overall, patients and caregivers expressed satisfaction with the program. <bold>Conclusions:</bold> A home-based NIV follow-up program is feasible and well-received by families. The potential reduction in hospitalizations could reduce infectious risks, healthcare costs, and improve patients' quality of life.