Using a home oxygen weaning protocol and pCO₂ to evaluate outcomes for infants with bronchopulmonary dysplasia discharged on home oxygen

Abstract

Background Predischarge capillary blood gas partial pressure of carbon dioxide (pCO2) has been associated with increased adverse events including readmission. This study aimed to determine if predischarge pCO2 or 36‐week pCO2 was associated with increased respiratory readmissions or other pulmonary healthcare utilization in the year after neonatal intensive care unit (NICU) discharge for infants with bronchopulmonary dysplasia (BPD) discharged with home oxygen, using a standardized outpatient oxygen weaning protocol. Methods This was a secondary cohort analysis of infants born <32 weeks gestational age with BPD, referred to our clinic for home oxygen therapy from either from our level IV NICU or local level III NICUs between 2015 and 2017. Infants with major nonrespiratory comorbidities were excluded. Subject information was obtained from electronic health records. Results Of 125 infants, 120 had complete 1‐year follow‐up. Twenty‐three percent of infants experienced a respiratory readmission after NICU discharge. There was no significant association between predischarge or 36‐week pCO2 and respiratory readmissions, emergency room visits, new or increased bronchodilators, or diuretics. Higher 36‐week pCO2 was associated with a later corrected age when oxygen was discontinued (<6 months; median, 54 mmHg; interquartile range [IQR], 51–61; 6–11 months; median, 62 mmHg; IQR, 57–65; ≥12 months, median, 66 mmHg; IQR, 58–73; p = .006). Conclusions Neither predischarge pCO2 nor 36‐week pCO2 was associated with 1‐year respiratory readmissions. However higher pCO2 at 36 weeks was associated with a longer duration of home oxygen. Neonatal illness measures like 36‐week pCO2 may be useful in communicating expectations for home oxygen therapy to families.

Management of diuretics in infants with bronchopulmonary dysplasia discharged on home oxygen

“…BPD was defined as respiratory support at 36 weeks postmenstrual age. [7][8][9] Infants with tracheostomies and surgical nonrespiratory comorbidities were excluded; only one member of a multiple gestation was included.…”

“…Home oxygen is weaned using a structured algorithm, which has been previously published. 7 We also have a standardized guideline for the management of diuretics. This algorithm is based on the most common diuretics that the infants are discharged home on which include chlorothiazide, hydrochlorothiazide, and combined spironolactone/hydrochlorothiazide.…”

“…Our outpatient BPD clinic uses a structured guideline to wean from home oxygen using recorded home oximetry and monthly clinic visits. 7 Along with home oxygen weaning guidelines, we recently introduced guidelines for active weaning of diuretic medications for all infants who did not otherwise require them for cardiovascular indications. The objective of this study was to evaluate whether actively weaning diuretics, instead of an alternative approach of allowing the infant to passively outgrow their dose, would be associated with prolonged weaning from oxygen or trigger unexpected visits.…”

Frequent hypoxemia found in infants with bronchopulmonary dysplasia after weaning home oxygen

“…29,30 Most providers utilize nighttime oxyhemoglobin saturations from oximetry to wean oxygen. 13 There are recent studies describing utilizing recorded home oximetry in an oxygen weaning protocol in place of a PSG, 31 but there are no published reports describing the desaturation index despite the link to the apnea −hypopnea index on PSG. 15 A recent report described employing downloadable home oximetry information to assist with weaning oxygen therapy at home outside of in-person visits, but this system requires the software, staffing resources, and monitoring available, as well as frequent family participation.…”

Inpatient education reduces length of outpatient oxygen therapy in bronchopulmonary dysplasia: A quality improvement project

“…Infants using this protocol are weaned from HOT in a median of 21 weeks after NICU discharge. 9 Prior studies have demonstrated that parental engagement and comfort in weaning HOT has a dose-dependent effect on the duration of HOT. 10 While we have a well-established outpatient protocol for weaning HOT, we noticed that poor preparedness with HOT led to problems on discharge.…”