Varying patterns of home oxygen use in infants at 23-43 weeks' gestation discharged from United States neonatal intensive care units

Abstract

Objectives: To compare proportions of infants at different gestational ages discharged from the neonatal intensive care unit (NICU) on home oxygen, to determine how many were classified with chronic lung disease based on timing of discharge on home oxygen, and to determine the percentage discharged on home oxygen who received mechanical ventilation.

Study design: We evaluated a retrospective cohort of infants of 23-43 weeks' gestational age discharged from 228 NICUs in 2009, using the Pediatrix Clinical Data Warehouse. Multilevel logistic regression analysis identified predictors of home oxygen use among extremely preterm, early-moderate preterm, late preterm, and term infants. Duration of mechanical ventilation and median length of stay were calculated for infants discharged on home oxygen.

Results: For the 48877 infants studied, the rate of home oxygen use ranged from 28% (722 of 2621) in extremely preterm infants to 0.7% (246 of 34 934) in late preterm and term infants. Extremely preterm infants composed 56% (722 of 1286) of the infants discharged on home oxygen; late preterm and term infants, 19% (246 of 1286). After gestational age, mechanical ventilation was the main predictor of home oxygen use; however, 61% of the late preterm and term infants discharged on home oxygen did not receive ventilation. The median length of hospital stay was 95 days (IQR, 76-114 days) for extremely preterm infants discharged on home oxygen, but only 15 days (IQR, 10-22 days) for late preterm and term ventilated infants discharged on home oxygen.

Conclusion: Although home oxygen use is uncommon in later-gestation infants, the greater overall numbers of later-gestation infants contribute significantly to the increased need for home oxygen for infants at NICU discharge. Neither respiratory failure nor lengthy hospitalization is a prerequisite for home oxygen use at later gestational age.

Keywords: AUC; Area under the curve; BPD; Bronchopulmonary dysplasia; CLD; Chronic lung disease; MAS; Meconium aspiration syndrome; NICU; Neonatal intensive care unit; PPHN; Persistent pulmonary hypertension of the newborn; ROC; Receiver operating characteristic.

Figure 1

A, Rates of home oxygen use by gestational age. Numbers above the bars indicate the number of infants in each group who were discharged with home oxygen therapy divided by the total number of infants in that gestational age group, along with the corresponding percentage. B, Gestational age distribution of the 1286 infants who were discharged on home oxygen therapy. The graphs show the gestational age group, number of infants in that gestational age group discharged with home oxygen therapy, and percentage of the total number of infants discharged with home oxygen therapy.

Figure 2

Distribution of gestational age and days of mechanical ventilation for the 1286 infants discharged on home oxygen therapy. The number in each stacked-column box indicates the number of infants at each gestational age and each duration of mechanical ventilation. The duration of mechanical ventilation for infants discharged with home oxygen therapy was significantly different by gestational age group (P < .001, χ² test).