Determining Optimal Home Oxygen Flow Rate For Infants With Bronchopulmonary Dysplasia (BPD) Using Near Infrared Spectroscopy

Objective: Near-infrared spectroscopy (NIRS) measures cerebral oxygenation and could measure the risk of hypoxia or hyperoxia in infants with bronchopulmonary dysplasia (BPD). We lack normalized data for NIRS values in neonates. We sought normative values of NIRS and proposed that NIRS could better identify a safe oxygen flow rate compared to pulse oximetry (POX). Methods: This prospective cohort study compared POX and NIRS values in healthy infants in room air (n = 22) with BPD infants (n = 10) on oxygen (0.03, 0.06, 0.12 L/min). Results: In healthy infants, the average POX value was 97.8%, and NIRS was 78.24%. Time (% time) with hypoxia was similarly low using either POX or NIRS (3.5% and 1.4%). On oxygen, % time with hypoxemia was similarly low with both POX or NIRS (0.03 lpm: 2.35% POX and 0.01% NIRS; 0.06 lpm: 1.43% POX and 0.6% NIRS; 0.12 lpm: 1.46% POX and 0.2% NIRS). In contrast, the potential hyperoxia %time was higher using POX compared to NIRS (96.5% vs 47.9%) in room air healthy infants. Similarly, hyperoxia %time was more common with POX compared to NIRS, but there was no difference with increasing oxygen flow rates (0.03 lpm, 82.13% POX and 41.5% NIRS; 0.06 lpm: 92.49% POX and 34.4% NIRS; 0.12 lpm: 87.00% POX and 34.8% NIRS). Conclusion: We did not see a dose response correlation between oxygen flow rate and time spent in the hyperoxemic range across different flow rates by POX or cerebral NIRS. We did not see a benefit of NIRS in setting home oxygen flow rates. Keywords: near infrared spectroscopy, hyperoxia, home oxygen