Using a home oxygen weaning protocol and pCO2 to evaluate outcomes for
infants with bronchopulmonary dysplasia discharged on home oxygen
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.