Respiratory Medications in Infants <29 Weeks during the First Year Postdischarge: The Prematurity and Respiratory Outcomes Program (PROP) Consortium

Abstract

Objective: To determine patterns of respiratory medications used in neonatal intensive care unit graduates.

Study design: The Prematurity Respiratory Outcomes Program enrolled 835 babies <29 weeks of gestation in the first week. Of 751 survivors, 738 (98%) completed at least 1, and 85% completed all 4, postdischarge medication usage in-person/telephone parental questionnaires requested at 3, 6, 9, and 12 months of corrected age. Respiratory drug usage over the first year of life after in neonatal intensive care unit discharge was analyzed.

Results: During any given quarter, 66%-75% of the babies received no respiratory medication and 45% of the infants received no respiratory drug over the first year. The most common postdischarge medication was the inhaled bronchodilator albuterol; its use increased significantly from 13% to 31%. Diuretic usage decreased significantly from 11% to 2% over the first year. Systemic steroids (prednisone, most commonly) were used in approximately 5% of subjects in any one quarter. Inhaled steroids significantly increased over the first year from 9% to 14% at 12 months. Drug exposure changed significantly based on gestational age with 72% of babies born at 23-24 weeks receiving at least 1 respiratory medication but only 40% of babies born at 28 weeks. Overall, at some time in the first year, 55% of infants received at least 1 drug including an inhaled bronchodilator (45%), an inhaled steroid (22%), a systemic steroid (15%), or diuretic (12%).

Conclusion: Many babies born at <29 weeks have no respiratory medication exposure postdischarge during the first year of life. Inhaled medications, including bronchodilators and steroids, increase over the first year.

Keywords: bronchopulmonary dysplasia; drug; prematurity.

Figure 1,

online – Participant flow diagram

Figure 2 –

Each bar represents the proportion of infants whose caregiver reported use of a medication in that class during the prior three-month period at the corrected age in months as noted. The proportion of those who were on at least one respiratory drug increased significantly over time, as did the use of inhaled steroids and inhaled bronchodilators. Conversely, diuretic use decreased significantly over the first year of life. (*P≤0.0005 by chi-square.) The denominators (n) for each time period are 712 (month 3), 708 (month 6), 688 (month 9), and 696 (month 12).

Figure 3,

online - Each bar represents the proportion of infants receiving at least one respiratory medication post-NICU discharge during the first year of life, vs. the proportion who received no respiratory medication, grouped by gestational age at birth. This was statistically significant (P<0.0001 by chi-square). The denominators (n) for each gestational age group are 83 (23–24 weeks), 98 (25 weeks), 135 (26 weeks), 169 (27 weeks), 156 (28 weeks), for a total of 641 babies who completed all four post-discharge visits.