Predictors of Successful Discontinuation of Supplemental Oxygen in Very Low-Birth-Weight Infants with Bronchopulmonary Dysplasia Approaching Neonatal Intensive Care Unit Discharge

Abstract

We sought to identify factors associated with readiness to discontinue supplemental oxygen and to gain weight in very low-birth-weight (VLBW) infants with bronchopulmonary dysplasia (BPD) approaching neonatal intensive care unit (NICU) discharge. From 2004 to 2009, VLBW infants ≥34 weeks' postmenstrual age (PMA) on nasal cannula supplemental oxygen were challenged with room air at rest, during activity, and feeding as routine care. Outcome and clinical data were collected retrospectively. Challenges were divided into derivation and validation cohorts. We performed comparative and hierarchical logistic regression analyses, constructing a predictive model with passed challenge as outcome. Of 233 infants (birth weight 901 ± 245 g, gestational age 26(6)/(7) ± 2 weeks), 988 had challenges at 38(2)/(7) ± 3 weeks' PMA. Weight gain was 12.4 ± 5 g/kg/d in the week following passed challenges and 11.2 ± 5.3 g/kg/d following failed challenges (p = 0.08). Increasing weight at time of challenge was associated with increased adjusted odds of passing. Increasing capillary pco(2), cannula flow rate, pulmonary acuity score, and history of patent ductus arteriosus (PDA) ligation decreased odds of passing. Receiver operating characteristic curve area was 0.82 in the validation cohort. The model performed well within pco(2) and pulmonary acuity score subgroups. Weight, pco(2), cannula flow rate, pulmonary acuity score, and history of PDA ligation identify infants with BPD ready to maintain saturation and gain weight without supplemental oxygen.

Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants

“…2 However, prophylactic indomethacin has not been shown to prevent bronchopulmonary dysplasia (BPD), despite a strong association between PDA and the development of BPD. 2–7 The available data from randomized trials are consistent with the hypothesis that prophylactic indomethacin may adversely affect respiratory outcomes. The most recent Cochrane Review on prophylactic indomethacin included 9 randomized controlled trials that assessed supplemental oxygen use at 28 days of life and only 1 trial, the Trial of Indomethacin Prophylaxis in Preterms (TIPP) that assessed supplemental oxygen use at 36 weeks postmenstrual age (PMA).…”

Using Measurements of Shunt and Ventilation-to-Perfusion Ratio to Quantify the Severity of Bronchopulmonary Dysplasia

“…Various clinical conditions have been implicated as potential risk factors for BPD, such as IUGR [18], lack of antenatal corticosteroids [19], low GA and birth weight [20], male gender [21], mechanical ventilation and supplemental oxygen [22] and presence of PDA [23]. As many of these factors are closely interrelated in clinical practice, it is difficult to isolate and describe their relative contribution to the severity of BPD in the context of an observational study [2].…”

Epidemiology of bronchopulmonary dysplasia

“…The role of a patent ductus arteriosus (PDA) in the development of BPD is much‐debated. There is strong evidence to support an association but not a causal relationship between persistent PDA and BPD (Palta et al, ; Rojas et al, ; Benitz, ; Trzaski et al, ). With the exception of a trial conducted over 30 years ago, no RCT has compared management strategies for prolonged exposure to PDA in premature infants requiring mechanical ventilation (Cotton et al, ).…”