Respiratory Medications in Infants <29 Weeks during the First Year Postdischarge: The Prematurity and Respiratory Outcomes Program (PROP) Consortium

Abstract

Objective: To determine patterns of respiratory medications used in neonatal intensive care unit (NICU) graduates. Study design: The Prematurity Respiratory Outcomes Program enrolled 835 babies <29 weeks gestation in the first week. Of 751 survivors, 738 (98%) completed at least 1, and 85% completed

Respiratory medication use in extremely premature (<29 weeks) infants during initial NICU hospitalization: Results from the prematurity and respiratory outcomes program

“…Diuretic use persists at hospital discharge. However, once PROP enrollees leave the NICU, their exposure to diuretics rapidly declines, while the use of inhaled steroids and bronchodilators increases over the first year of life . This may reflect lack of efficacy, the natural evolution of neonatal chronic lung disease, or differing practices between primary care and subspecialty providers, and between inpatient and outpatient providers.…”

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

“…For infants with BPD discharged with home oxygen, one example of close outpatient management may be the use of inhaled and systemic steroids, which we noted to be more common in infants with a higher predischarge pCO 2 . Ryan et al 9 similarly found in the Prematurity and Respiratory Outcomes Program that inhaled steroids and bronchodilators increased over the first year. It possible that outpatient management such as early use of inhaled or systemic steroids helps prevent our highest‐risk patients from being admitted or presenting to the emergency room.…”

“…Infants with greater severity of BPD are at higher risk of health complications after Neonatal Intensive Care Unit (NICU) discharge 3,4 . During the first year of life they are at increased risk of being readmitted to the hospital, and frequently receive home oxygen therapy and additional medications such as inhaled and systemic corticosteroids 5–9 . For this reason, strategies to optimize safe NICU discharge for infants with BPD are an important focus of research.…”

<p>Bronchopulmonary Dysplasia: An Overview</p>

“…[17][18][19][20] BPD remains the most prevalent sequela of preterm birth in the United States, affecting 41-46% of infants born at <29 weeks' gestation or 10,000-14,000 preterm infants annually in the United States. 3,4,6,[21][22][23][24][25] Although the use of antenatal steroids, surfactant, and sophisticated ventilator strategies have improved survival, the rates of BPD have remained relatively constant. 6,26,27 Member institutions in the Vermont-Oxford Network (VON) reported an average incidence of BPD of 29%, but the rates at individual sites varied from 13.4-66% in 2001 and 4-58% in 2003.…”

“…64 During hospitalization, PROP found that the use of diuretics decreased significantly over time, while the use of inhaled bronchodilators and steroids increased. 22 Without evidence that diuretic use helps in the prevention of BPD, with side effect profiles previously discussed, they are likely "one of the most abused (drugs) without evidence of substantive benefit. 82 "…”