Home Oxygen Use for Preterm Infants with Bronchopulmonary Dysplasia in California

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Healthcare Quality Improvement

Background:

• Bronchopulmonary dysplasia (BPD) is a common complication in preterm infants, often necessitating long-term respiratory support.
• Home oxygen therapy is a critical intervention for infants with BPD, but its utilization and associated factors require further investigation.
• Understanding predictors and hospital variation in home oxygen use is essential for optimizing care and resource allocation.

Purpose of the Study:

• To identify clinical and hospital-level predictors of home oxygen use in preterm infants diagnosed with BPD.
• To assess the extent of hospital variation in prescribing home oxygen therapy across a statewide cohort.
• To examine the relationship between home oxygen use and the timing of discharge from the neonatal intensive care unit (NICU).

Main Methods:

• Secondary analysis of data from the California Perinatal Quality Care Collaborative, including infants born <32 weeks gestation with BPD at 36 weeks postmenstrual age (PMA).
• Logistic mixed-effects modeling was used to identify risk factors for home oxygen use, with center as a random effect.
• Observed-to-expected ratios were calculated to quantify hospital variation, and Spearman correlation assessed the relationship between PMA at discharge and home oxygen use.

Main Results:

• Of 7846 infants with BPD, 47% were discharged on home oxygen. Key predictors included antenatal steroids, maternal hypertension, earlier gestational age, male sex, ductus arteriosus ligation, increased ventilator days, nitric oxide use, and discharge from regional hospitals.
• Significant hospital variation in home oxygen use was observed, ranging from 7% to 95%. Approximately 42% of hospitals had significantly different observed rates than expected based on patient characteristics.
• Community hospitals with higher observed home oxygen use rates demonstrated an earlier median PMA at discharge (correlation -0.27, P=.024).

Conclusions:

• Clinical factors and hospital characteristics significantly predict home oxygen use in preterm infants with BPD.
• There is substantial variation in home oxygen prescribing practices across hospitals in California.
• Community hospitals utilizing more home oxygen tend to discharge infants at an earlier postmenstrual age, suggesting a potential association with length of stay.