Factors of late respiratory support or oxygen weaning in infants with bronchopulmonary dysplasia

Abstract

Objectives: Bronchopulmonary dysplasia (BPD) is the most common complication in preterm infants. This study aimed at identifying factors associated with early or with late or weaning failure from respiratory support or oxygen (O₂) in preterm infants with BPD requiring respiratory support or O₂ therapy after discharge from the neonatal intensive care unit (NICU).

Methods: This retrospective study was conducted in the NICU of a tertiary hospital, in infants born before 32 weeks of gestation between 2012 and 2021, and discharged from the NICU with a respiratory support (tracheostomy [TT], invasive ventilation [IV], Non-IV [NIV], continuous positive airway pressure [CPAP], high flow nasal canula [HFNC]) or O₂ therapy for BPD. Univariate and multivariate analyses were performed to identify factors associated with early weaning (before 6 months postmenstrual age [PMA]) or late (after 6 months PMA) and weaning failure.

Results: Among the 53 infants included (2% TT, 2% IV, 11% NIV, 25% CPAP or HFNC, 60% O₂ at NICU discharge), 23 (43%) were weaned from respiratory support or O₂ before 6 months PMA and 39 (73%) before 12 months PMA. IV duration during NICU stay and postnatal steroid treatment were identified as factors associated with a late or weaning failure (OR 1.03, p = .04 and OR 4.11, p = .023, respectively).

Conclusion: In this study, nearly half of preterm infants with severe BPD were weaned from respiratory support or O₂ before 6 months PMA. IV duration and postnatal steroid treatment during NICU stay were associated with a late or weaning failure.

Keywords: bronchopulmonary dysplasia; infants; prematurity; respiratory support; weaning.

Figure 1

Flow chart. Early weaning: weaning before 6 months PMA. Late weaning: weaning between 6 and 12 months PMA. Weaning failure: not weaned at 12 months PMA or death. BPD, bronchopulmonary dysplasia; NICU, neonatal intensive care unit; O₂, oxygen; PMA, postmenstrual age.

Figure 2

Change in type of respiratory support between discharge from the NICU and 12 months PMA. *returning home was either directly after NICU discharge or after a stay in another unit. 2 patients died after NICU discharge and before returning home. Weaning were considered if the infants were weaned from both respiratory support and O₂ therapy. CPAP, continuous positive airway pressure; HFNC, high flow nasal canula; IV, invasive ventilation; NICU, neonatal intensive care unit; NIV, noninvasive ventilation; PMA, postmenstrual age. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 3

Kaplan−Meier survival curve of weaning from respiratory support or oxygen. (A) Cumulative event is corresponding to the weaning event from both O₂ (oxygen) therapy and respiratory support over the time in months PMA (postmenstrual age). Median weaning age: 7.5 months PMA. x on the curve was corresponding to dead event. (B) Cumulative event corresponds to the weaning event. For patient under respiratory support, weaning were considered if the infants were weaned from both respiratory support and O₂ therapy. Median weaning age for patients under O₂ therapy: 5.1 months PMA. Median weaning age for patients under respiratory support: 11.2 months PMA. x on the curve was corresponding to dead event. O₂, oxygen; PMA postmenstrual age. [Color figure can be viewed at wileyonlinelibrary.com]