Background: Infants with Bronchopulmonary Dysplasia (BPD) are often prescribed diuretics before the neonatal intensive care unit (NICU) discharge. It is unknown whether outpatient medication weaning strategies affect duration of home oxygen therapy. Methods: This was a secondary cohort analysis of infants born <32 weeks gestational age with BPD from 2015-2018 discharged from our NICU or regional NICUs, referred to our pulmonary clinic for home oxygen management. We compared three groups: those discharged with no diuretics, diuretics actively weaned (dose decreased) and diuretics passively weaned (dose not adjusted). Results: Out of 125 infants, 116 were included in the analysis. Forty-five infants were discharged without diuretics; 52 infants were discharged with diuretics that were actively weaned; 19 infants were discharged with diuretics that were passively weaned. Infants who were passively weaned spent the most time on home oxygen (median 28 weeks, IQR 16-52; p=0.011); there were no differences in home oxygen duration in infants actively weaned (median 13 weeks, IQR 10-26) versus not on diuretics (median 22 weeks, IQR 12-30, p=0.285). Multivariable adjustment for other illness characteristics associated with duration of home oxygen did not change this finding. Conclusions: Active weaning of diuretics did not prolong duration of home oxygen, in the setting of a standardized clinical guideline for weaning home oxygen in infants with BPD. These data can serve as baseline information to implement and test standardized strategies for outpatient medication management.

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.