Project Overview

Infants with bronchopulmonary dysplasia (BPD), are at risk of poor cardiorespiratory control, and chronic and intermittent hypoxemia for months after birth. They have up to 60 episodes of intermittent hypoxemia (IH) per day. IH leads to apathological cascade of oxidative stress and injury and clinical morbidities including cognitive and language delay, motorimpairment, and death. Up to 30% of hypoxemic spells in children are clinically undetectable. In the neonatal intensive care unit (NICU), pulse oximetry is used to monitor and adjust oxygen needs of preterm infants up to 41 times/day. This vigilance is crucial because untreated hypoxemia for even a few minutes causes pulmonary inflammation, neurological damage, and death. The current problem: At home, this vigilance is not possible. The oximeters used in NICUs are cumbersome and rapidly cause parental fatigue and incompliance . Even if an infant is monitored, difficulties intransmitting data for clinical evaluation prevents timely intervention. Lack of evidence leads to lack of consistent advice, variability in practice and parental anxiety, frustration, and non-compliance. Some parents resort to non-medical grade oximeters with questionable accuracy. Others (29%) become non-compliant, and 32% self- wean their infants from oxygen without medical guidance. The current outcome: By 1 year, 53% of infants with BPD would have been hospitalized at least once, mostly (81%) for respiratory problems. Many have >2 emergency department presentations, >16 specialist attendances, >33 pathology tests, and>6 diagnostic imaging tests, costing ~$182,312/year to health system and at least ~$2,212 to parents. Later, respiratory and neurological function declines, resulting in poor quality of life even death in adulthood. What must we change? Oxygen is one ofthe 479 World Health Organization (WHO) essential medications that are vital for human health. To ensure oxygen is given safely,the WHO Pulse Oximetry project recommends monitoring of every child at risk of hypoxia. Due to lack of high-levelevidence, guidance for care of Canadian infants with BPD are unclear, leading to the health problems that stretch alreadyscarce resources. Oxygen management is also inequitable, with remote and Indigenous infants being 3 times less likely to be prescribed home oxygen therapy. What we offer: We will use technological advances spurred by COVID-19 pandemic to digitally innovate oxygen needs of infants with BPD at home. Using a wearable oximeter and a virtual care package (Masimo Safety Net) that was used safely and effectively to manage thousands of adult COVID-19 patients at home instead of the hospital, we will aim to improve oxygen management and health and decrease hospitalization in BPD infants. This is a low-risk, COVID-Safe proposal using devices and communication systems (i.e., smartphones and Wi-Fi). The overall aim will be is a large RCT, which will bring equity of care to remote and Indigenous families with difficulties accessing medical care, fills a knowledge gaps by finally acquiring home oximetry data and future proof home management of infants at risk of hypoxia with the creation of predictive algorithms from our innovative data.