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Outpatient respiratory outcomes in children with BPD on supplemental oxygen
Julianne R McGlynn1, Brianna C Aoyama2, Amanda Martin1
1Division of Pulmonary Medicine and Sleep and Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Children with bronchopulmonary dysplasia (BPD) requiring supplemental oxygen (O2) were slower to wean if they had certain medical conditions or socioeconomic factors. O2 levels at discharge did not impact outpatient respiratory symptoms or acute care needs.
Area of Science:
- Pediatrics
- Neonatology
- Pulmonology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in preterm infants.
- Supplemental oxygen (O2) is often required in the outpatient setting for these children.
- Understanding factors influencing O2 use and weaning is crucial for managing BPD.
Purpose of the Study:
- To identify patient characteristics and demographics associated with the need for supplemental oxygen at discharge.
- To determine factors affecting the timing of supplemental oxygen liberation (weaning).
- To examine the association between supplemental oxygen levels and respiratory symptoms or acute care usage in the outpatient setting.
Main Methods:
- Retrospective analysis of BPD patients on supplemental oxygen.
- Data collected from Johns Hopkins University and Children's Hospital of Philadelphia (2008-2021).
- Utilized chart review and caregiver questionnaires.
Main Results:
- Higher O2 levels at discharge were linked to severe BPD, pulmonary hypertension, and older age.
- Weaning to room air was slower in children on higher O2 levels.
- Weaning delays were associated with gastrostomy tubes, inhaled corticosteroids, public insurance, and lower income.
Conclusions:
- BPD severity and discharge O2 levels did not correlate with outpatient acute care usage or respiratory symptoms.
- O2 weaning was significantly influenced by socioeconomic status and respiratory medication use.
- These factors contribute to variability in outpatient O2 weaning for BPD patients.
Introduction:
Preterm children with bronchopulmonary dysplasia (BPD) frequently require supplemental oxygen in the outpatient setting. In this study, we sought to determine patient characteristics and demographics associated with need for supplemental oxygen at initial hospital discharge, timing to supplemental oxygen liberation, and associations between level of supplemental oxygen and likelihood of respiratory symptoms and acute care usage in the outpatient setting.
Methods:
A retrospective analysis of subjects with BPD on supplemental oxygen (O2 ) was performed. Subjects were recruited from outpatient clinics at Johns Hopkins University and the Children's Hospital of Philadelphia between 2008 and 2021. Data were obtained by chart review and caregiver questionnaires.
Results:
Children with BPD receiving ≥1 L of O2 were more likely to have severe BPD, pulmonary hypertension, and be older at initial hospital discharge. Children discharged on higher levels of supplemental O2 were slower to wean to room air compared to lower O2 groups (p < 0.001). Additionally, weaning off supplemental O2 in the outpatient setting was delayed in children with gastrostomy tubes and those prescribed inhaled corticosteroids, on public insurance or with lower household incomes. Level of supplemental O2 at discharge did not influence outpatient acute care usage or respiratory symptoms.
Conclusion:
BPD severity and level of supplemental oxygen use at discharge did not correlate with subsequent acute care usage or respiratory symptoms in children with BPD. Weaning of O2 however was significantly associated with socioeconomic status and respiratory medication use, contributing to the variability in O2 weaning in the outpatient setting.
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