Using a home oxygen weaning protocol and pCO 2 to evaluate outcomes for infants with bronchopulmonary dysplasia discharged on home oxygen

• Published in: Pediatric pulmonology Vol. 55; no. 12; pp. 3293 - 3303
• Main Authors: Dawson, Sara K, D'Andrea, Lynn A, Lau, Ryan, Lagatta, Joanne M
• Format: Journal Article
• Language: English
• Published: United States 01.12.2020
• Subjects: Bronchopulmonary Dysplasia - therapy; Carbon Dioxide; Female; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Male; Oxygen Inhalation Therapy - methods; Partial Pressure; Patient Discharge; Patient Readmission; bronchopulmonary dysplasia; pCO2; home oxygen therapy
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.25057

Predischarge capillary blood gas partial pressure of carbon dioxide (pCO ) has been associated with increased adverse events including readmission. This study aimed to determine if predischarge pCO or 36-week pCO was associated with increased respiratory readmissions or other pulmonary healthcare utilization in the year after neonatal intensive care unit (NICU) discharge for infants with bronchopulmonary dysplasia (BPD) discharged with home oxygen, using a standardized outpatient oxygen weaning protocol. This was a secondary cohort analysis of infants born <32 weeks gestational age with BPD, referred to our clinic for home oxygen therapy from either from our level IV NICU or local level III NICUs between 2015 and 2017. Infants with major nonrespiratory comorbidities were excluded. Subject information was obtained from electronic health records. 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 predischarge or 36-week pCO and respiratory readmissions, emergency room visits, new or increased bronchodilators, or diuretics. Higher 36-week pCO was associated with a later corrected age when oxygen was discontinued (<6 months; median, 54 mmHg; interquartile range [IQR], 51-61; 6-11 months; median, 62 mmHg; IQR, 57-65; ≥12 months, median, 66 mmHg; IQR, 58-73; p = .006). Neither predischarge pCO nor 36-week pCO was associated with 1-year respiratory readmissions. However higher pCO at 36 weeks was associated with a longer duration of home oxygen. Neonatal illness measures like 36-week pCO may be useful in communicating expectations for home oxygen therapy to families.