Introduction
Preterm birth comprises 10.1% of all births in the United States.1 With advances in neonatal care, survival rates of premature infants have improved, especially for those born at extremely low birth weights.2 These low birth weight infants are at highest risk for developing bronchopulmonary dysplasia (BPD) and to minimize hypoxemia events, are more likely to be discharged to home on supplemental oxygen. In a single center study, approximately 1/3 of preterm infants with BPD who were followed in the outpatient setting were initially discharged to home on oxygen therapy.3 Clinical practice guidelines from both the American Thoracic Society and British Thoracic Society recommend home oxygen therapy for infants with BPD with ongoing hypoxemia.4 5 However, variations in supplemental oxygen use and weaning strategies in children with BPD,6 may influence outpatient respiratory outcomes, particularly during the first three years of life.
BPD is characterized by alveolar hypoplasia and small airway disease. Achieving normal oxygen levels in children with BPD can help promote somatic growth, optimize developmental outcomes and minimize the development or worsening of pulmonary hypertension.7In the outpatient setting however, few guidelines for weaning supplemental oxygen in children with BPD exist; thus variability in respiratory outcomes and timing to liberation from supplemental oxygen is common. When comparing children with BPD on supplemental oxygen at discharge to those on room air several studies have reported higher rates of hospitalizations and healthcare utilization in those discharged on supplemental oxygen.8,9 However, another study found no differences in these outcomes between the two groups.10
In this study, we focused on children with BPD discharged on supplemental oxygen (O2). The purpose of this study was to determine whether an association existed between level of supplemental oxygen use at discharge and subsequent outpatient acute care usage and respiratory symptoms in this study population. Secondly, we sought to identify patient characteristics and demographics that may be associated with the variability in the timing of liberation from supplemental oxygen in children with BPD, following initial hospital discharge.