Respiratory Outcomes Stratified by ICS Therapy
Respiratory outcomes that were assessed, included having a diagnosis of
asthma as well as acute care use before and after the first pulmonary
clinic visit under the assumption that subjects receiving ICS therapy
were all prescribed it by the conclusion of their pulmonary visit. In
terms of acute care usage prior to the first pulmonary visit, subjects
initiated on ICS therapy as outpatients had more absolute numbers of
emergency department (ED) visits (p <0.001) and hospital
admissions (p <0.001) than those on ICS therapy at NICU
discharge or not started at all (Supplemental Table 3 ). There
were no differences in acute care usage after first pulmonary clinic
visit between the three groups.
The frequency of asthma diagnosis (73.4%) in those initiated on ICS
therapy as outpatients was much higher than in those on ICS therapy at
NICU discharge (51.9%) or not initiated at all (36.4%;p <0.001). However, given that differences in the age at
the time of first pulmonary clinic visit existed
(p <0.001), as well as duration of follow-up time
(p =0.001) between the three groups, we also performed adjusted
logistic regression to account for these differences and to adjust for
potential confounders related to prematurity. Adjusted logistic
regression revealed that children started on an ICS at any point as an
outpatient had a higher likelihood of an ED visit (2.68±0.70;p <0.001) and/or rehospitalization (4.81±1.16;p <0.001) prior to their first outpatient pulmonary
visit compared to children never on an ICS (Table 4 ). After any
time following the first pulmonary visit, the likelihood of ED visits
and re-hospitalizations for those started on ICS therapy as an
outpatient, dropped to 1.73±0.35 (p =0.007) and 1.78±0.37
(p =0.006), respectively, when compared to children never on an
ICS. There were no differences in the likelihood of ED visits or
rehospitalizations between those on ICS therapy at NICU discharge versus
those never on an ICS.
The likelihood of a diagnosis of asthma was higher in both children
started on an ICS as an outpatient (3.58±0.84; p <0.001)
and those prescribed an ICS continuously since NICU discharge
(1.97±0.65; p =0.040) compared to those never on an ICS.
Additionally, of those diagnosed with asthma in the outpatient setting,
the time until asthma diagnosis was earliest in the children started on
an ICS as an outpatient (p <0.001) (Figure 1 ).