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, morbimortality, and oxygen monitoring up to 6 months in OD preterm infants. (2) To explore associations between oxygen weaning, perinatal history, Hb levels, transfusions, feeding patterns, and growth.Methods: A prospective cohort study. Descriptive and multivariate analysis.Results: Recruited patients were 407 with 33 weeks median gestational age (GA).Mothers presented infections >28%, pre-eclampsia in 22%, and 80% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age, and hospital stay were 36 weeks, 21 and 17 days, respectively; 56.8% of patients had neonatal sepsis and 67.8% were admitted to the neonatal intensive care unit. At oxygen weaning, patients had a median of 54 days with oxygen, median weight 3240 g and GA 41 weeks. Median follow-up oxygen saturation was 94% with 1/64-1/2 L/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 67% were breastfeeding.Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement while invasive ventilation and transfusions had the opposite effect (R 2 = .49). 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.

Follow-up of Kangaroo Mother Care programmes in the last 28 years: results from a cohort of 57 154 low-birth-weight infants in Colombia

“…This is followed by ambulatory KMCP sessions with strict monitoring through dynamic oximetry. Sessions are initially daily and later weekly until 40 weeks GA, then every 2 weeks until oxygen weaning 22…”

“…The KMCPs started to receive in 1998 infants with early discharge in KP with ambulatory oxygen due to the confidence of the professionals in the follow-up performed in these programs and at the same time the most immature children started to survive but with a more aggressive handling which was reflected in the peak of BPD in 2008 which went down progressively because of therapeutic advances (eg, less mechanical ventilation and fewer perinatal infections). Additionally, with the nutritional strategy of promoting and supplementing breast feeding when necessary, even the most immature Kangaroo babies with BPD, followed up in the three KMCPs of excellence, achieved an anthropometric growth similar to patients without BPD 22…”

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

“…One of the excluded studies related to chronic lung disease in term babies. There are eight studies from the US, one from the UK, 24 one from China 25 and one from Colombia 21 . The PRISMA flowchart illustrates the search results.…”

Nutrition and growth in infants with established bronchopulmonary dysplasia

“…Data suggest that use of breast milk may be associated with reduced emergency department visits and need for systemic steroids in young children with BPD, 35 while data on reduction in hospitalization for lower respiratory tract infection is mixed 36 . Recent data have suggested that exclusive breastfeeding in infants may be associated with lower oxygen need in BPD infants following initial discharge 37 . Adequate protein intake is necessary to promote linear growth, lung growth, and repair of damaged tissue 38 .…”