Home Oxygen Use for Preterm Infants with Bronchopulmonary Dysplasia in California

Abstract

Objective(s):To identify predictors of home oxygen use in preterm infants with bronchopulmonary dysplasia in a statewide cohort, identify hospital variation in home oxygen use, and determine the relationship between home oxygen use and NICU discharge timing. Study design:This was a secondary analysis of California Perinatal Quality Care Collaborative data. Infants were born <32 weeks' gestation, diagnosed with bronchopulmonary dysplasia based on respiratory support at 36 weeks postmenstrual age, and discharged home. Risk factors for home oxygen use were identified using a logistic mixed model with center as random effect. Estimates were used to calculate each center's observed to expected ratio of home oxygen use, and a Spearman coefficient between center median postmenstrual age at discharge and observed and expected proportions of home oxygen use.Results: 3672/7846 (47%) infants with bronchopulmonary dysplasia were discharged with home oxygen. Higher odds of home oxygen use were seen with antenatal steroids, maternal hypertension, earlier gestational age, male sex, ductus arteriosus ligation, more ventilator days, nitric oxide, discharge from regional hospitals, and postmenstrual age at discharge (ROC area under the curve 0.85). Of 92 hospitals, home oxygen use ranged from 7-95%; 42% of observed home oxygen use was significantly higher or lower than expected given patient characteristics. The 67 community hospitals with higher observed rates of home oxygen had earlier median postmenstrual age at discharge (correlation −0.27, p=0.024). Conclusion:Clinical and hospital factors predict home oxygen use. Home oxygen use varies across California, with community centers using more home oxygen having a shorter length of stay.

Predictors of home oxygen duration in chronic neonatal lung disease

“…Many of the variables that predict home oxygen in CNLD such as early GA, low birth weight, invasive ventilation time, or total duration of respiratory support did not predict oxygen weaning within 12 months CGA 6,7 . Our finding that infants who were discharged on higher oxygen flow rates required home oxygen therapy for longer is similar to what has been reported previously 12 .…”

“…Of those requiring home oxygen, 340 (81.3%) also had very low birth weight (< 1500 g) 3 . In Canada and the United States, the annual reported prevalence of extremely premature infants with CNLD and chronic oxygen dependency is between 25% and 59% 5–8 . Home oxygen facilitates earlier hospital discharge and is generally favored as it reduces the risk of nosocomial infections and may improve quality of life in the comfort of a home environment 9,10 .…”

“…Population‐based cohort studies have identified predictors of requiring home oxygen at hospital discharge but to our knowledge, no studies have evaluated predictors of home oxygen therapy duration in CNLD 6,7 . Thus, the primary aim of this study was to identify predictors of home oxygen therapy duration in premature infants with CNLD.…”

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

“…Clinical practice guidelines of the American Thoracic Society recommend home oxygen therapy for infants with BPD who have chronic hypoxemia; home oxygen therapy is used in at least half of infants with BPD discharged from U.S. NICUs 18–21 . After NICU discharge, however, there are few published guidelines for the close monitoring required to wean home oxygen therapy in the outpatient setting 20,22,23 .…”

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

“…A U.S multicentre cohort from 2008–2016, included 7846 cases of BPD and reported 47% discharged on HOT. HOT was significantly more likely if patients were male, born at lower GA, had more ventilator days, received nitric oxide or PDA ligation …”