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Using a home oxygen weaning protocol and pCO2 to evaluate outcomes for infants with bronchopulmonary dysplasia discharged on home oxygen
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  • Sara Dawson,
  • Lynn D'Andrea,
  • Ryan Lau,
  • Joanne Lagatta
Sara Dawson
Medical College of Wisconsin
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Lynn D'Andrea
Medical College of Wisconsin
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Ryan Lau
Medical College of Wisconsin
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Joanne Lagatta
Medical College of Wisconsin
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Abstract

Background: Elevated Pre-discharge capillary blood gas partial pressure of carbon dioxide (pCO2) has been associated with increased adverse events including readmission. This study aimed to determine if pre-discharge pCO2 or 36-week pCO2 was associated with increased respiratory readmissions or other pulmonary healthcare utilization in the year after NICU discharge for infants with BPD discharged with home oxygen, using a standardized outpatient oxygen weaning protocol. Methods: This was a secondary cohort analysis of infants born <32 weeks gestational age with BPD, referred to our Pulmonary clinic for home oxygen therapy either from our level IV NICU or local level III NICUs between 2015-17. Infants with major non-respiratory comorbidities were excluded. Subject information was obtained from electronic health records. Results: Of 125 infants, 120 had complete 1-year follow-up. Twenty three percent of infants experienced a respiratory readmission after NICU discharge. There was no significant association between pre-discharge or 36-week pCO2 and respiratory readmissions, emergency room visits, new or increased bronchodilators or diuretics. Higher 36-week pCO2 was associated with a later corrected age when oxygen was discontinued (<6 months, median 54 mm Hg, Interquartile range (IQR) 51-61; 6-11 months, median 62 mm Hg IQR 57-65; ≥12 months, median 66 mm Hg, IQR 58-73; p=0.006). Conclusions: Neither pre-discharge pCO2 nor 36-week pCO2 was associated with one-year respiratory readmissions. Higher pCO2 at 36 weeks was associated with longer duration of home oxygen. Neonatal illness measures like 36-week pCO2 may be useful in communicating expectations for home oxygen therapy to families.

Peer review status:Published

23 Jun 2020Submitted to Pediatric Pulmonology
24 Jun 2020Submission Checks Completed
24 Jun 2020Assigned to Editor
26 Jun 2020Reviewer(s) Assigned
24 Jul 2020Review(s) Completed, Editorial Evaluation Pending
12 Aug 20201st Revision Received
13 Aug 2020Submission Checks Completed
13 Aug 2020Assigned to Editor
13 Aug 2020Reviewer(s) Assigned
02 Sep 2020Review(s) Completed, Editorial Evaluation Pending
02 Sep 2020Editorial Decision: Accept
08 Sep 2020Published in Pediatric Pulmonology. 10.1002/ppul.25057