Home oxygen for children: who, how and when?

uring a recent review of the England and Wales domiciliary oxygen service by the British Thoracic Society Home Oxygen Working Party, a separate review of paediatric services was conducted as there are many differences between the requirements for adults and children. It soon became clear that there is a lack of consensus about fundamental paediatric issues such as the ideal target oxygen saturation. This is critical as it determines who needs home oxygen, how much should be given, and when it is no longer necessary. A lack of agreement and the enormous variety of practice in babies with chronic lung disease has been highlighted by surveys from North America on the initiation of home oxygen 1 and from the UK and Ireland on weaning off home oxygen. Earlier recommendations for children have been outlined in a report from the Royal College of Physicians of London Working Group in 1992 and, although the main document is no longer available, the summary can still be obtained. The revised 1999 report from the Royal College of Physicians 4 included a paediatric section, and much of this review is based on that, together with relevant updates. Unfortunately, there is a lack of randomised controlled trial evidence to inform much of the debate.