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Updated: May 23, 2025
Conducting Respiratory Oscillometry in an Outpatient Setting
Published on: April 8, 2022
Outpatient Respiratory Outcomes in Extremely Preterm Children During the First 3 Years of Life
Cynara Leon1, Pallavi Kawatra1, Amanda Martin1
1Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Extremely preterm infants with bronchopulmonary dysplasia (BPD) face higher risks for activity limitations. However, race, ethnicity, and public insurance significantly impact outpatient respiratory outcomes, irrespective of gestational age.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Public Health
Background:
- Extremely preterm infants face the highest risk of developing bronchopulmonary dysplasia (BPD).
- Understanding outpatient respiratory outcomes in this vulnerable population is crucial for targeted interventions.
- Gestational age is a key determinant of BPD severity and long-term respiratory health.
Purpose of the Study:
- To investigate the relationship between gestational age and respiratory outcomes in children with BPD in an outpatient setting.
- To compare respiratory morbidity in extremely preterm infants versus very preterm infants with BPD.
- To identify factors influencing outpatient respiratory health beyond gestational age.
Main Methods:
- Retrospective analysis of 1025 preterm children with BPD from specialized outpatient clinics.
- Comparison of extremely preterm infants (22-24 and 25-27 weeks gestation) with a reference group (28-32 weeks gestation).
- Statistical analysis using Chi-squared tests, t-tests, and ANOVA to evaluate outcomes.
Main Results:
- Infants born <25 weeks gestation had higher rates of severe BPD, supplemental oxygen use at discharge, public insurance, and Black race.
- Extremely preterm children (22-24 weeks) showed increased activity limitations in outpatient settings.
- Hispanic ethnicity and public insurance were associated with increased healthcare utilization (sick visits, hospital admissions, ED visits) and symptom burden.
Conclusions:
- Extremely preterm infants (22-24 weeks gestation) experience greater activity limitations post-discharge.
- Outpatient respiratory outcomes in BPD are significantly influenced by socioeconomic factors like public insurance and race/ethnicity, overriding gestational age.
- Further research should focus on addressing disparities in care for preterm infants with BPD.
Rationale:
Extremely preterm infants are at highest risk for developing bronchopulmonary dysplasia (BPD). This study aimed to examine the relationship between gestational age and respiratory outcomes in children with BPD in the outpatient setting.
Methods:
Data were collected from 1025 preterm children with BPD recruited from outpatient bronchopulmonary (BPD) clinics at Johns Hopkins and Children's Hospital of Philadelphia (CHOP). Extremely preterm children (22-24 and 25-27 weeks gestation) were compared to a reference group of very preterm children (28-32 weeks gestation). Data were analyzed using Χ2 tests, t-tests, and ANOVA tests.
Results:
Infants born at < 25 weeks gestation were more likely to have severe BPD (71.9%), be discharged on supplemental oxygen (50.7%), have public insurance, and self-report as Black (60.4%) compared to those born > 25 weeks. In the outpatient setting, extremely preterm children (22-24 weeks gestation) had a higher likelihood of activity limitation (OR 1.72) compared to very preterm infants. Hispanic children, regardless of gestational age, were more likely to have sick visits (OR 2.09) and a hospital admission (OR 2.15) compared to non-Hispanic children. Children with public insurance had a higher likelihood of ED visits (OR 1.48), hospital admissions (OR 1.49), systemic steroid use (OR 1.39), nighttime respiratory symptoms (OR 1.66), and activity limitations (OR 1.61) compared to privately insured children.
Conclusions:
After initial hospital discharge, extremely preterm children (22-24 weeks gestation) have a higher likelihood of activity limitation. However, other factors including race/ethnicity and public insurance are more likely driving outpatient respiratory outcomes regardless of gestational age.
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