Anemia, nutrition and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants.

Abstract

Background: In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care program (KMCP) with ambulatory oxygen, strict follow-up and oxygen weaning protocols. Objectives: 1) to describe growth and morbimortality up to 6 months of an OD preterm infants’ cohort. 2) to explore the association between oxygen requirement, perinatal history, Hb levels, transfusions, feeding patterns and growth. Methods: Prospective cohort study. Descriptive and multivariate analysis. Results: 445 patients were recruited with 33 weeks median gestational age (GA). 21% of mothers had preeclampsia, 50% infections and 77% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age and hospital stay were 36 weeks, 19 and 17 days, respectively; 55.6% of patients had neonatal sepsis and 66.6% were admitted to Neonatal Intensive Care Unit. Patients had on average 52 days with oxygen, a median of 3200g and 42 weeks GA at oxygen weaning. Median follow-up oxygen saturation was 94% with 0.016-0.5 l/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 66% were breastfeeding. Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement whilst invasive ventilation and transfusions had the opposite effect (R2=0.48). Conclusions: In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.