Home Oxygen Therapy for Thai Preterm Infants with Bronchopulmonary Dysplasia. What Are the Predictive Factors for Successful Weaning: A 20-year Review

Abstract

Abstract Background Consequences of lung injury and inflammation in preterm infants with bronchopulmonary dysplasia (BPD) contribute to prolonged oxygen requirements. Home oxygen therapy (HOT) is an alternative way of respiratory support in BPD infants. However, there is no consensus on weaning guidelines either under the supervision of physicians or unsupervised weaning by parents. Our objective is to identify the median age of home oxygen discontinuation and the factors that might predict the duration of HOT in a resource poor country. Methods All preterm (≤ 36 weeks' gestation) infants diagnosed BPD who required HOT after discharged from Ramathibodi Hospital during January 2000 – December 2019 comprised this retrospective study. Timing of HOT withdrawal was identified. Demographic data, severity of BPD, history of respiratory support, procedures, prenatal history, comorbidities, and complications were recorded and analyzed as factors associated of home oxygen withdrawal. Results Of 8581 preterm infants born during the 20-year period, 563 (6.6%) had BPD. Among 40 infants treated with HOT, 18 (45%) were successfully weaned oxygen within 12 months. The median corrected age (CA) of oxygen withdrawal was 13.8 months (8.5, 22.1). Longer duration of total respiratory support, longer length of hospital stay, and poor weight gain were associated with longer duration of HOT. Greater weight gain was associated with a shorter duration of HOT at 12 months CA (adjusted OR, 1.97; 95% CI, 1.13–3.23; p = 0.015). Conclusions The median corrected age of oxygen withdrawal in Thai BPD infants was 13.8 months. Severe BPD and poor weight gain were associated with prolonged home oxygen use. Despite not being able to follow all the guidelines due to economic constraints, the clinical outcomes were comparable to the resource rich countries.