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Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease
Published on: August 24, 2019
Management of diuretics in infants with bronchopulmonary dysplasia discharged on home oxygen
Sara K Dawson1, Lynn A D'Andrea1, Joanne M Lagatta2
1Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, and Children's Wisconsin, Milwaukee, Wisconsin, USA.
Insights
Actively weaning diuretics in infants with bronchopulmonary dysplasia (BPD) did not extend home oxygen therapy duration. This finding supports standardized outpatient medication management strategies for BPD infants.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Pharmacology
Background:
- Infants with bronchopulmonary dysplasia (BPD) often receive diuretics before neonatal intensive care unit (NICU) discharge.
- The impact of outpatient diuretic weaning strategies on home oxygen therapy duration in BPD infants remains unclear.
Purpose of the Study:
- To investigate whether different outpatient diuretic weaning strategies influence the duration of home oxygen therapy in infants with BPD.
Main Methods:
- A secondary cohort analysis included 116 infants born before 32 weeks gestational age with BPD.
- Infants were categorized into three groups: no diuretics, actively weaned diuretics, and passively weaned diuretics.
- Home oxygen therapy duration was compared across these groups.
Main Results:
- Infants whose diuretics were passively weaned spent significantly longer on home oxygen (median 28 weeks).
- No significant difference in home oxygen duration was observed between infants actively weaned (median 13 weeks) and those not on diuretics (median 22 weeks).
- Multivariable analysis confirmed these findings, adjusting for other relevant illness characteristics.
Conclusions:
- Active weaning of diuretics does not appear to prolong home oxygen therapy duration in BPD infants under a standardized weaning guideline.
- These findings provide a baseline for developing and testing standardized outpatient medication management protocols for BPD.
Background:
Infants with bronchopulmonary dysplasia (BPD) are often prescribed diuretics before the neonatal intensive care unit (NICU) discharge. It is unknown whether outpatient medication weaning strategies affect the duration of home oxygen therapy.
Methods:
This was a secondary cohort analysis of infants born <32 weeks gestational age with BPD from 2015 to 2018 discharged from our NICU or regional NICUs, referred to our pulmonary clinic for home oxygen management. We compared three groups: those discharged with no diuretics, diuretics actively weaned (dose decreased), and diuretics passively weaned (dose not adjusted).
Results:
Out of 125 infants, 116 were included in the analysis. Forty-five infants were discharged without diuretics, 52 infants were discharged with diuretics that were actively weaned, and 19 infants were discharged with diuretics that were passively weaned. Infants who were passively weaned spent the most time on home oxygen (median 28 weeks, interquartile range [IQR] 16-52; p = 0.011); there were no differences in home oxygen duration in infants actively weaned (median 13 weeks, IQR 10-26) versus not on diuretics (median 22 weeks, IQR 12-30, p = 0.285). Multivariable adjustment for other illness characteristics associated with the duration of home oxygen did not change this finding.
Conclusions:
Active weaning of diuretics did not prolong the duration of home oxygen, in the setting of a standardized clinical guideline for weaning home oxygen in infants with BPD. These data can serve as baseline information to implement and test standardized strategies for outpatient medication management.
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