Oxygen weaning after hospital discharge in children with bronchopulmonary dysplasia

Abstract

Summary Background In the United States, approximately 12,000 preterm infants are diagnosed with bronchopulmonary dysplasia (BPD) and many of these infants require supplemental oxygen after initial hospital discharge. In children with BPD we sought to identify factors associated with supplemental oxygen use after initial hospital discharge, factors associated with duration of supplemental oxygen use, and methods used to wean off supplemental oxygen in the home environment. Methods All subjects (n = 420) with the diagnosis of BPD were recruited from a single center Bronchopulmonary Dysplasia Clinic between 2008 and 2013. Subject information was obtained from patient history records, patient demographics, and caregiver questionnaires. Results Younger gestational age and having a Nissen fundoplication were associated with home supplemental oxygen use in subjects with BPD. Of the 154 subjects who received supplemental oxygen at home, 38% received flows ≤1/8 LPM, 30% received flows >1/8 LPM and ≤1/4 LPM, 21% received flows >1/4 LPM and ≤1/2 LPM, and 11% received flows >1/2 LPM. Among subjects receiving ≤1/8 LPM of oxygen, the median age of weaning off oxygen was 10.1 months, but increased depending on level of oxygen flow at initial outpatient visit. Of the 137 subjects weaned off of oxygen during the study period, weaning was not supervised by a physician in 32.1% of subjects. Conclusion Home supplemental oxygen use is common in infants diagnosed with BPD. In this study, the median age of weaning off supplemental oxygen was 10.1 months after initial hospital discharge. Unsupervised weaning of supplemental oxygen occurred in 32.1% of subjects with BPD.

Risk prediction tool for use and predictors of duration of postoperative oxygen therapy in children undergoing non-cardiac surgery: a case-control study

“…Fourth, minimizing the risk of prolonged oxygen therapy, by minimizing the risk score, should also result in a reduced duration of postoperative oxygen therapy. If oxygen therapy is absolutely necessary, for example when given as a prophylaxis in high risk children or when a respiratory event occurs during anesthesia, weaning children off oxygen therapy should be considered in those who have a low (≤ 7) or intermediate (8–11) risk score as soon as possible when signs and symptoms of hypoxia have improved in order to minimize the consequences of excessive use of postoperative oxygen therapy [ 28 , 29 ]. It has been suggested that an audit of the criteria used for prescribing oxygen such as target saturations, oxygen device used, and indication for use, would help wean children off postoperative oxygen therapy [ 30 ].…”

Bronchopulmonary dysplasia: A review of the pulmonary sequelae in the post‐surfactant era

“…A recent retrospective study from the John Hopkins Hospital, USA 2008–2013, of 154 cases of preterm infants diagnosed with BPD and treated with HOT reported the median age of weaning off oxygen was 12.5 months (95% CI: 10.9–14.2). Children with a continued need for oxygen >12 months of age were more likely to be older at discharge (mean age 3.8 months ±1.3 (0.1–0.72) vs. 5.9 months ±3.7 (2.0–24.5), P < 0.001) and have a gastrostomy tube (13.9% vs. 52.4%, P < 0.001) …”

Aerodigestive sampling reveals altered microbial exchange between lung, oropharyngeal, and gastric microbiomes in children with impaired swallow function

“…Clinicians often assume these pneumonias result from the aspiration of refluxed gastric contents and frequently treat these children with antireflux surgery, fundoplication [3, 4]. Despite this common surgical practice [5, 6], there are no pediatric studies which conclusively show improved pulmonary outcomes after fundoplication, suggesting that the respiratory symptoms seen in aspirating patients may not be related to aspiration of gastric contents [7, 8, 9, 10, 11]. An alternative hypothesis is that aspiration-related respiratory symptoms may result from aspirated oropharyngeal contents.…”