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Prospective Risk Stratification Identifies Healthcare Utilization Associated with Home Oxygen Therapy for Infants
Joanne M Lagatta1, Liyun Zhang1, Ke Yan1
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Insights
Prospective classification identified lower-risk infants with bronchopulmonary dysplasia discharged on home oxygen. These infants had fewer rehospitalizations compared to higher-risk infants, indicating effective risk stratification for neonatal intensive care unit graduates.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Care
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting preterm infants.
- Effective risk stratification is crucial for managing infants with BPD post-discharge.
- Home oxygen therapy is common for BPD infants, but identifying lower-risk candidates is essential.
Purpose of the Study:
- To evaluate if prospective classification identifies lower-risk infants with BPD for home oxygen discharge.
- To determine if these lower-risk infants experience fewer rehospitalizations within one year post-discharge.
- To compare rehospitalization rates among different risk groups of infants with BPD.
Main Methods:
- Prospective, single-center cohort study (2016-2019) of infants with BPD.
- Defined "lower-risk" based on oxygen flow, absence of pulmonary hypertension/airway comorbidities, and blood gas levels.
- Compared three discharge groups: lower-risk room air, lower-risk home oxygen, and higher-risk home oxygen.
Main Results:
- 145 infants included: 22% lower-risk room air, 32% lower-risk home oxygen, 44% higher-risk.
- Lower-risk home oxygen infants had similar rehospitalization rates (18%) to room air (16%) and lower rates than higher-risk infants (39%).
- Lower-risk home oxygen infants had more specialty visits (10) than room air infants (6).
Conclusions:
- Prospective classification effectively identifies lower-risk infants with BPD for home oxygen.
- Discharge with home oxygen for lower-risk infants did not increase rehospitalizations compared to room air.
- Lower-risk infants on home oxygen utilized more specialty care, suggesting a need for continued monitoring.
Objective:
To test whether prospective classification of infants with bronchopulmonary dysplasia identifies lower-risk infants for discharge with home oxygen who have fewer rehospitalizations by 1 year after neonatal intensive care unit discharge.
Study Design:
This is a prospective single-center cohort that included infants from 2016 to 2019 with bronchopulmonary dysplasia, defined as receiving respiratory support at 36 weeks of postmenstrual age. "Lower-risk" infants were receiving ≤2 L/min nasal cannula flow, did not have pulmonary hypertension or airway comorbidities, and had blood gas partial pressure of carbon dioxide <70 mm Hg. We compared 3 groups by discharge status: lower-risk room air, lower-risk home oxygen, and higher-risk home oxygen. The primary outcome was rehospitalization at 1 year postdischarge, and the secondary outcomes were determined by the chart review and parent questionnaire.
Results:
Among 145 infants, 32 (22%) were lower-risk discharged in room air, 49 (32%) were lower-risk using home oxygen, and 64 (44%) were higher-risk. Lower-risk infants using home oxygen had rehospitalization rates similar to those of lower-risk infants on room air (18% vs 16%, P = .75) and lower rates than higher-risk infants (39%, P = .018). Lower-risk infants using home oxygen had more specialty visits (median 10, IQR 7-14 vs median 6, IQR 3-11, P = .028) than those on room air. Classification tree analysis identified risk status as significantly associated with rehospitalization, along with distance from home to hospital, inborn, parent-reported race, and siblings in the home.
Conclusions:
Prospectively identified lower-risk infants discharged with home oxygen had fewer rehospitalizations than higher-risk infants and used more specialty care than lower-risk infants discharged in room air.
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