Home oxygen use and 1-year outcome among preterm infants with bronchopulmonary dysplasia discharged from a Chinese regional NICU

Abstract

ObjectiveThis study aims to compare the clinical characteristics and 1-year outcomes of preterm infants with bronchopulmonary dysplasia (BPD) who were discharged on supplemental oxygen or room air.Materials and MethodsThe preterm infants (born <32 weeks’ gestation, birth weight ≤1,250 g) diagnosed with BPD and admitted between January 2020 and December 2020 were enrolled. The clinical data during hospitalization were collected through the hospital’s electronic record system. The outcomes after discharge were acquired from the outpatient system and through telephonic interviews.ResultsOf the 87 preterm infants diagnosed with BPD, 81 infants survived until discharge. The 81 infants were divided into the home oxygen group (n = 29) and room air group (n = 52) according to supplemental oxygen or not at discharge. Infants in the home oxygen group were more likely to receive postnatal systemic steroids and higher ventilation settings at 36 weeks’ PMA. There was one patient in each group who died before 1 year corrected age, respectively. All the infants had successfully weaned off oxygen eventually during the first year. The median duration of home oxygen therapy was 25 (7,42) days. Readmission occurred in 49 (64.5%) infants. Readmissions for infants with home oxygen were more often related to respiratory disease. In addition, wheezing disorders and home inhalation occurred more frequently in the home oxygen group (p = 0.022, p = 0.004). Although the incidence of underweight at 1 year corrected age was higher in the room air group (10.0 vs. 3.8%), there was no significant difference (p = 0.620). The rate of neurodevelopmental impairment was similar between these two groups (26.0 vs. 30.8%, p = 0.659).ConclusionsIt was the first study focused on preterm infants with BPD receiving home oxygen in China. Infants with home oxygen were more likely to have respiratory problems after discharge from NICU. Home oxygen use was not associated with more readmission for infants with BPD, and no difference was found in neurodevelopmental impairment and growth outcome.

Family Integrated Care Shortens the Duration of Home Oxygen Therapy in Infants With Bronchopulmonary Dysplasia

“…A prospective study from China showed that home oxygen use was not associated with higher rehospitalization rate for infants with BPD, and no risk was found in neurodevelopmental impairment and growth. But, when compared with the room air group, infants in the HOT group were more likely to have respiratory problems after discharging from NICU ( P = .007) 25. As a matter of fact, in the first year of life, 118 of 238 (49%) infants with BPD were rehospitalized, more than twice the rate of rehospitalization of the non-BPD population, which was 309 of 1359 (23%) ( P ≤ .0001) 26.…”

“…But, when compared with the room air group, infants in the HOT group were more likely to have respiratory problems after discharging from NICU (P = .007). 25 As a matter of fact, in the first year of life, 118 of 238 (49%) infants with BPD were rehospitalized, more than twice the rate of rehospitalization of the non-BPD population, which was 309 of 1359 (23%) (P ≤ .0001). 26 The prospective study by Zhang et al 27 reported that infants in the family-centered care group had higher weight gain (886 grams vs 542 grams), shorter LOS in NICU (43 days vs 46 days), and, more importantly, decreased rehospitalization rate at 1 week (41.9% vs 70.0%) and at 1 month (6.5% vs 50.0%) than those in the non-FIC group.…”

Outpatient respiratory outcomes in children with BPD on supplemental oxygen

“…The burden of respiratory morbidities in children with BPD can be lifelong 13 and identifying those at highest risk for long‐term respiratory morbidities, is challenging. Children with BPD who require supplemental oxygen at initial hospital discharge have varying degrees of cardiopulmonary involvement and are likely at higher risk for chronic respiratory symptoms during the pre‐school years when compared to children discharged off supplemental oxygen 14 . Identifying factors that predict outpatient acute care usage, chronic respiratory symptoms and timing to oxygen liberation could help modify respiratory morbidities in these children.…”

“…Children with BPD who require supplemental oxygen at initial hospital discharge have varying degrees of cardiopulmonary involvement and are likely at higher risk for chronic respiratory symptoms during the pre-school years when compared to children discharged off supplemental oxygen. 14 Identifying factors that predict outpatient acute care usage, chronic respiratory symptoms and timing to oxygen liberation could help modify respiratory morbidities in these children. This study focused on children with BPD discharged to home on supplemental oxygen to address these issues.…”

Types of home respiratory support in children with bronchopulmonary dysplasia and factors determining its duration: A scoping review

“…Following our inclusion and exclusion criteria, 11 studies were finally included in this review. [15][16][17][18][19][20][21][22][23][24][25] Most of the excluded studies were review articles and not original studies as such. One of the excluded studies related to chronic lung disease in term babies.…”