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No clear benefit seen for postdischarge oxygen in preemies with BPD

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Clinical trials needed to study oxygen use in preterm infants

While oxygen use recommendations for preterm infants in the delivery room and neonatal ICU have changed, postdischarge oxygen instructions have largely not, with variations among practices and evidence for its use not well established.

The results from DeMauro et al., while not establishing causality, can instead be used to design a prospective trial to identify which preterm infants with BPD require oxygen post discharge, Reese H. Clark, MD, and Veeral N. Tolia, MD, wrote in a related editorial.

Supplemental oxygen also was associated with greater resource use among infants in the study, and they were more likely to require medications for asthma and BPD, procedures such as tracheotomy, and rehospitalization, which is in line with previous clinical studies analyzing oxygen use in the NICU, they noted.

The findings by DeMauro et al. could be used to improve the design and safety of a prospective study. For example, “it may not be feasible or ethical to include some infants with more severe BPD in future trials,” they noted. “Once again, we are challenged to reevaluate our clinical beliefs and biases about the use of oxygen,” said Dr. Clark and Dr. Tolia. “Now we must collaborate to design and implement a trial to help us determine which infants should receive oxygen after discharge. We look forward to seeing those results.”

Dr. Clark is from the Center for Research and Education at MEDNAX in Sunrise, Fla., and Dr. Tolia is at Baylor University Medical Center and Pediatrix Medical Group in Dallas. This is a summary of the editorial accompanying the report by DeMauro et al. (Pediatrics. 2019 Apr 11. doi: 10.1542/peds.2019-0372). They reported no relevant financial disclosures or external funding.



Preterm infants with bronchopulmonary dysplasia (BPD) discharged with supplemental oxygen showed slightly better weight and significantly improved weight-for-length scores, but were more likely to use medical resources and had rates of neurodevelopmental impairment similar to those of infants not discharged with oxygen, according to research published in Pediatrics.

Premature infant in incubator Herjua/Thinkstock

“With this study, we provide important and novel information that may aid the decision of whether to discharge an infant with supplemental oxygen, particularly for those infants who might be weaned off by some clinicians and not by others,” wrote Sara B. DeMauro, MD, MSCE, of University of Pennsylvania, Philadelphia, and Children’s Hospital of Philadelphia, and her colleagues. “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.”

Dr. DeMauro and her colleagues examined 1,039 preterm infants with BPD given supplemental oxygen by nasal cannula between January 2006 and December 2014, who were propensity matched to infants in a control group with a similar severity of BPD who were not discharged with oxygen. The infants were born at less than 27 weeks’ gestation and began receiving oxygen therapy or respiratory support at 36 weeks’ postmenstrual age. These infants were then measured for growth, neurodevelopment, and resource use from discharge to follow-up at 22-26 months corrected age.

At follow-up, infants discharged with oxygen showed marginal weight improvement scores (adjusted mean difference, 0.11) and significantly improved weight-for-length scores (adjusted mean difference, 0.13), but they had rates of neurodevelopmental impairment similar to those of infants with BPD discharged without supplemental oxygen. In addition, infants discharged with oxygen had a greater likelihood of rehospitalization due to respiratory illness (adjusted relative risk, 1.33), use of asthma or BPD medication (adjusted RR, 1.30), and use of medical equipment such as a pulse oximeter (adjusted RR, 2.94).

The researchers noted that their study’s design prevented them from examining all infants with BPD discharged with supplemental oxygen and what factors influenced discharge of infants with supplemental oxygen, as well as the effects of various durations of supplemental oxygen exposure.

“Definitive evaluation of the risk/benefit ratio of this therapy will require prospective controlled trials,” Dr. DeMauro and her colleagues wrote. “Such research will facilitate a more evidence-based approach to clinical decisions about postdischarge care of infants with BPD.”

This study received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and the National Institutes of Health. The authors reported no relevant financial disclosures.

SOURCE: DeMauro SB et al. Pediatrics. 2019 Apr 11. doi: 10.1542/peds.2018-2956.

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