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Respiratory Medications in Infants <29 Weeks during the First Year Postdischarge: The Prematurity and Respiratory
Rita M Ryan1, Roberta L Keller2, Brenda B Poindexter3
1Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Insights
Many premature infants (<29 weeks gestation) do not require respiratory medications after neonatal intensive care unit discharge. Inhaled bronchodilators and steroids use increased during the first year for these high-risk infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Graduates of neonatal intensive care units (NICU), especially those born extremely preterm (<29 weeks gestation), often require respiratory support and medication post-discharge.
- Understanding patterns of respiratory medication use in this vulnerable population is crucial for optimizing care and predicting outcomes.
Purpose of the Study:
- To investigate the patterns and trends of respiratory medication usage in the first year after discharge among infants born before 29 weeks of gestation.
Main Methods:
- The Prematurity Respiratory Outcomes Program enrolled 835 infants <29 weeks gestation.
- Postdischarge medication usage was assessed via parental questionnaires at 3, 6, 9, and 12 months corrected age for 751 survivors.
- Respiratory drug utilization was analyzed over the first year of life.
Main Results:
- While 66%-75% of infants received no respiratory medication quarterly, 55% received at least one drug during the first year.
- Inhaled bronchodilator (albuterol) use increased significantly from 13% to 31%.
- Diuretic use decreased from 11% to 2%, while inhaled steroid use rose from 9% to 14% by 12 months.
- Infants born earlier (23-24 weeks) had higher medication exposure (72%) compared to those born at 28 weeks (40%).
Conclusions:
- A significant proportion of extremely preterm infants do not require respiratory medications in the first year post-NICU discharge.
- There is a notable increase in the use of inhaled bronchodilators and steroids over the first year of life for these infants.
Objective:
To determine patterns of respiratory medications used in neonatal intensive care unit graduates.
Study Design:
The Prematurity Respiratory Outcomes Program enrolled 835 babies <29 weeks of gestation in the first week. Of 751 survivors, 738 (98%) completed at least 1, and 85% completed all 4, postdischarge medication usage in-person/telephone parental questionnaires requested at 3, 6, 9, and 12 months of corrected age. Respiratory drug usage over the first year of life after in neonatal intensive care unit discharge was analyzed.
Results:
During any given quarter, 66%-75% of the babies received no respiratory medication and 45% of the infants received no respiratory drug over the first year. The most common postdischarge medication was the inhaled bronchodilator albuterol; its use increased significantly from 13% to 31%. Diuretic usage decreased significantly from 11% to 2% over the first year. Systemic steroids (prednisone, most commonly) were used in approximately 5% of subjects in any one quarter. Inhaled steroids significantly increased over the first year from 9% to 14% at 12 months. Drug exposure changed significantly based on gestational age with 72% of babies born at 23-24 weeks receiving at least 1 respiratory medication but only 40% of babies born at 28 weeks. Overall, at some time in the first year, 55% of infants received at least 1 drug including an inhaled bronchodilator (45%), an inhaled steroid (22%), a systemic steroid (15%), or diuretic (12%).
Conclusion:
Many babies born at <29 weeks have no respiratory medication exposure postdischarge during the first year of life. Inhaled medications, including bronchodilators and steroids, increase over the first year.
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