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Published on: April 8, 2022
Utilization trends of respiratory medication in premature infants discharged on home oxygen therapy
Heather White1, Alice Berenson2, Javed Mannan1
1Division of Neonatology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts.
Insights
Respiratory medication use in infants with bronchopulmonary dysplasia on home oxygen therapy is variable. Inhaled steroids did not shorten the duration of home oxygen therapy in these premature infants.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Bronchopulmonary dysplasia (BPD) affects approximately 50% of extremely preterm infants.
- A third of these infants require home oxygen therapy (HOT) after discharge.
- No prior studies have investigated respiratory medication use in BPD infants on HOT.
Purpose of the Study:
- To examine respiratory medication utilization in infants diagnosed with bronchopulmonary dysplasia (BPD) who are receiving home oxygen therapy (HOT).
- To analyze the relationship between respiratory medication use and the duration of HOT in this vulnerable population.
Main Methods:
- A multicenter, randomized trial (recorded home oximetry trial) compared two home oxygen management strategies.
- Respiratory medication prescriptions and dosages were collected from enrollment until 6 months post-HOT discontinuation.
- Infants were monitored monthly while on HOT and at 1, 3, and 6 months after discontinuation.
Main Results:
- Respiratory medication use was documented in 89% of infants during protocol visits.
- Medication use was higher at initial follow-up compared to NICU discharge, decreasing by the 6-month follow-up.
- Inhaled steroid (IS) use before weaning was associated with a longer mean HOT duration (138 days) compared to post-weaning IS use (55 days).
- Time-to-event analysis showed a significant difference between the no IS and post-wean IS groups (P=.004).
- Pulmonary clinics prescribed significantly more medications (5.5/patient) than NICU clinics (0.8/patient).
Conclusions:
- Respiratory prescribing patterns for infants on HOT exhibit significant variability.
- The utilization of inhaled steroids was not found to be associated with a shorter duration of home oxygen therapy in this cohort.
Background:
Roughly half of all extremely preterm infants will be diagnosed with bronchopulmonary dysplasia (BPD), and a third will be discharged on home oxygen therapy (HOT). To date, there have been no studies that have examined the relationship between respiratory medication utilization in infants with BPD on HOT.
Methods:
The recorded home oximetry trial was a multicenter, randomized trial comparing two home oxygen management strategies in premature infants. Infants were enrolled at first outpatient pulmonary or neonatal intensive care unit (NICU) follow-up visit with a pulmonary component. Respiratory medication prescriptions and dosage were collected from time of enrollment through 6 months after HOT discontinuation. Patients were seen monthly while on HOT and at 1, 3, and 6 months after successful discontinuation.
Results:
During protocol visits, 174 (89%) infants had respiratory medications documented. Respiratory medication use was higher at initial follow-up visit compared with NICU discharge and decreased at the final 6-month follow-up visit. Infants who received inhaled steroids (IS) before weaning had mean HOT duration of 138 days (range: 24-562 days); infants who received IS after weaning had shorter mean HOT duration (55 days, range: 21-264). In time-to-event analysis the no IS group and the postwean group differed significantly (χ21 = 8.1; P = .004). NICU clinics gave a total of 35 prescriptions to 43 patients, an average of 0.8 per patient, while the pulmonary clinics gave 837 prescriptions to 153 patients, or 5.5 per patient (P < .0001).
Conclusion:
Respiratory prescribing patterns for infants on HOT are highly variable. Utilization of IS was not associated with shorter duration of HOT.
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