Introduction
Preterm birth comprises 10.1% of all births in the United
States.1 With advances in neonatal care, survival
rates of premature infants have improved, especially for those born at
extremely low birth weights.2 These low birth weight
infants are at highest risk for developing bronchopulmonary dysplasia
(BPD) and to minimize hypoxemia events, are more likely to be discharged
to home on supplemental oxygen. In a single center study, approximately
1/3 of preterm infants with BPD who were followed in the outpatient
setting were initially discharged to home on oxygen
therapy.3 Clinical practice guidelines from both the
American Thoracic Society and British Thoracic Society recommend home
oxygen therapy for infants with BPD with ongoing
hypoxemia.4 5 However, variations in
supplemental oxygen use and weaning strategies in children with
BPD,6 may influence outpatient respiratory outcomes,
particularly during the first three years of life.
BPD is characterized by alveolar hypoplasia and small airway disease.
Achieving normal oxygen levels in children with BPD can help promote
somatic growth, optimize developmental outcomes and minimize the
development or worsening of pulmonary hypertension.7In the outpatient setting however, few guidelines for weaning
supplemental oxygen in children with BPD exist; thus variability in
respiratory outcomes and timing to liberation from supplemental oxygen
is common. When comparing children with BPD on supplemental oxygen at
discharge to those on room air several studies have reported higher
rates of hospitalizations and healthcare utilization in those discharged
on supplemental oxygen.8,9 However, another study
found no differences in these outcomes between the two
groups.10
In this study, we focused on children with BPD discharged on
supplemental oxygen (O2). The purpose of this study was
to determine whether an association existed between level of
supplemental oxygen use at discharge and subsequent outpatient acute
care usage and respiratory symptoms in this study population. Secondly,
we sought to identify patient characteristics and demographics that may
be associated with the variability in the timing of liberation from
supplemental oxygen in children with BPD, following initial hospital
discharge.