Postdischarge Oxygen and Neurodevelopment in Bronchopulmonary Dysplasia

Despite marginal improvement in growth and increased use of resources, no association has been found between postdischarge oxygen and neurodevelopment in infants with bronchopulmonary dysplasia, according to study results recently published in Pediatrics.

This propensity score-matched cohort study included 2914 infants who were born at <27 weeks’ gestation and who were receiving oxygen or respiratory support at 36 weeks’ postmenstrual age. Of these, 57.9% (n=1688) received a discharge on home oxygen whereas 42.1% (n=1226) received a discharge breathing in-room air. Assessments took place at 18 to 26 months’ corrected age. Discharge with supplemental oxygen from the initial newborn hospitalization period constituted the primary exposure, with primary outcomes including rehospitalization because of respiratory illness in the period before follow-up, as well as follow-up weight z score. Secondary outcomes included growth parameters, use of medical resources, and neurodevelopment. Multivariable models were used to compare outcomes between matched groups, with log binomial models employed to evaluate adjusted relative risks and Poisson models for count outcomes.

A marginally improved weight z score was found in infants receiving oxygen compared with infants breathing in-room air (adjusted mean difference 0.11; 95% CI, 0.00-0.22; P =.05). Weight-for-length z scores at 18-26 months’ corrected age were also respectively improved (adjusted mean difference 0.13; 95% CI, 0.06-0.20; P <.001), despite poor overall growth during early childhood (most z scores <0 at 2 years’ corrected age). Rehospitalization because of respiratory illness was more likely in infants receiving oxygen (adjusted relative risk 1.33; 95% CI, 1.16-1.53; P <.001) as was the use of respiratory equipment and medications. Both groups showed similar neurodevelopmental impairment and behavioral outcomes.

Limitations to this study include the exclusion of some infants who were discharged on oxygen, thus limiting the study’s results to those infants who can be weaned off oxygen before discharge. Furthermore, there was a lack of data on factors influencing the decision to discharge infants given supplemental oxygen.

The study researchers concluded that “this study helps to clarify, both for clinicians and parents, the potential benefits and harms that might be expected from home oxygen therapy among the subset of infants for whom the best course of action is unclear. Definitive evaluation of the risk/benefit ratio of this therapy will require prospective controlled trials. Such research will facilitate a more evidence-based approach to clinical decisions about postdischarge care of infants with [bronchopulmonary dysplasia].”

Reference

DeMauro SB, Jensen EA, Bann CM, et al. Home oxygen and 2-year outcomes of preterm infants with bronchopulmonary dysplasia [published online April 11, 2019]. Pediatrics. doi: 10.1542/peds.2018-2956