Home Oxygen Use and 1-Year Readmission among Infants Born Preterm with Bronchopulmonary Dysplasia Discharged from Children's Hospital Neonatal Intensive Care Units

Lagatta, Joanne; Murthy, Karna; Zaniletti, Isabella; Bourque, Stephanie L.; Engle, William A.; Rose, Rebecca S.; Ambalavanan, Namasivayam; Brousseau, David C.

doi:10.1016/j.jpeds.2020.01.018

Cited by 29 publications

(29 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We saw the same non-association between pCO2 and readmission in the referral group, but similar to our NICU group, few referral infants had high pCO2s prior to discharge. Considering our readmission rate for infants discharged with home oxygen therapy was not high, it is possible that close outpatient follow up was successful in controlling symptoms that otherwise may have led to readmissions 14,15 . Infants were seen in pulmonary clinic 4-6 weeks following discharge from the NICU, and then every 4-6 weeks to 2-3 months until they were off supplemental oxygen.…”

Section: Discussionmentioning

confidence: 97%

“…This raises the issue of whether to continue the recommendation to delay discharge for infants with higher pCO2. Our institution's time to discharge for infants with BPD is still similar or shorter than other children's hospital institutions, so the impact on NICU length of stay would likely be modest 14 . But if close outpatient follow-up can mitigate some potential risks, there may be benefits to individual patients by facilitating earlier discharge.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Dawson

Andrea

Lau

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Elevated Pre-discharge capillary blood gas partial pressure of carbon dioxide (pCO2) has been associated with increased adverse events including readmission. This study aimed to determine if pre-discharge pCO2 or 36-week pCO2 was associated with increased respiratory readmissions or other pulmonary healthcare utilization in the year after NICU discharge for infants with 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 Pulmonary clinic for home oxygen therapy either from our level IV NICU or local level III NICUs between 2015-17. Infants with major non-respiratory 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 pre-discharge 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 mm Hg, Interquartile range (IQR) 51-61; 6-11 months, median 62 mm Hg IQR 57-65; [?]12 months, median 66 mm Hg, IQR 58-73; p=0.006). Conclusions: Neither pre-discharge pCO2 nor 36-week pCO2 was associated with one-year respiratory readmissions. Higher pCO2 at 36 weeks was associated with longer duration of home oxygen. Neonatal illness measures like 36-week pCO2 may be useful in communicating expectations for home oxygen therapy to families.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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

Dawson

Andrea

Lau

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Based on our findings to date, we cannot broadly recommend predischarge pCO 2 in criteria for safe discharge of infants with BPD. At our institution, the time to discharge for infants with BPD is still similar or shorter than other children's hospital institutions, so changing this recommendation would likely have a relatively small impact on NICU length of stay 15 . But if close outpatient follow‐up can mitigate some potential risks, there may be benefits to individual patients by facilitating earlier discharge.…”

Section: Discussionmentioning

confidence: 99%

“…We saw the same non‐association between pCO 2 and readmission in the referral group, but similar to our NICU group, few referral infants had high pCO 2 s before discharge. Considering our readmission rate for infants discharged with home oxygen therapy was not high, it is possible that close outpatient follow up was successful in controlling symptoms that otherwise may have led to readmissions 15,16 . Infants were seen in pulmonary clinic 4–6 weeks following discharge from the NICU, and then every 4–6 weeks to 2–3 months until they were off supplemental oxygen.…”

Section: Discussionmentioning

confidence: 99%

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

Dawson

DʼAndrea

Lau

et al. 2020

Pediatric Pulmonology

View full text Add to dashboard Cite

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.

show abstract

“…Similar to other diseases, differences in outpatient outcomes for infants and children with preterm respiratory disease have been observed in those covered by private versus public insurance, although it is not clear whether these differences stem from differences in access to care associated with different means of health-care coverage or other disparities associated with insurance coverage (e.g., income). For preterm infants, Medicaid coverage has been associated with a higher risk of readmission in most studies [46,47,58], but not all [51]. These increased rehospitalizations could be related to a reported association between Medicaid and the development of asthma (OR: 1.8) among preterm infants [59].…”

Section: Health Insurancementioning

confidence: 92%

Influences of environmental exposures on preterm lung disease

Collaco¹,

Aoyama²,

Rice³

et al. 2021

Expert Review of Respiratory Medicine

View full text Add to dashboard Cite

Introduction: Environmental factors play a critical role in the progression or resolution of chronic respiratory diseases. However, studies are limited on the impact of environmental risk factors on individuals born prematurely with lung disease after they leave the neonatal intensive care unit and are discharged into the home environment. Areas covered:In this review, we cover current knowledge of environmental exposures that impact outcomes of preterm respiratory disease, including air pollution, infections, and disparities. The limited data do suggest that certain exposures should be avoided and there are potential preventative strategies for other exposures. There is a need for additional research outside the neonatal intensive care unit that focuses on individual and community-level factors that affect long-term outcomes.Expert opinion: Preterm respiratory disease can impose a significant burden on infants, children, and young adults born prematurely, but may improve for many individuals over time. In this review, we outline the exposures that may potentially hasten, delay, or prevent resolution of lung injury in preterm children.

show abstract

Home Oxygen Use and 1-Year Readmission among Infants Born Preterm with Bronchopulmonary Dysplasia Discharged from Children's Hospital Neonatal Intensive Care Units

Cited by 29 publications

References 39 publications

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

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

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

Influences of environmental exposures on preterm lung disease

Contact Info

Product

Resources

About