Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Pediatrics. 2019 May;143(5). doi: 10.1542/peds.2018-2956. Epub 2019 Apr 11.
To compare medical and developmental outcomes over the first 2 years of life in extremely preterm infants with bronchopulmonary dysplasia (BPD) who were discharged on supplemental oxygen via nasal cannula with outcomes of infants with a similar severity of respiratory illness who were discharged breathing in room air.
We performed a propensity score-matched cohort study. Eligible infants were born at <27 weeks' gestation, were receiving supplemental oxygen or respiratory support at 36 weeks' postmenstrual age, and were assessed at 18 to 26 months' corrected age. Study outcomes included growth, resource use, and neurodevelopment between discharge and follow-up. Outcomes were compared by using multivariable models adjusted for center and age at follow-up.
A total of 1039 infants discharged on supplemental oxygen were propensity score matched 1:1 to infants discharged breathing in room air. Infants on oxygen had a marginal improvement in weight score (adjusted mean difference 0.11; 95% confidence interval [CI] 0.00 to 0.22), with a significantly improved weight-for-length score (adjusted mean difference 0.13; 95% CI 0.06 to 0.20) at 22 to 26 months' corrected age. Infants on oxygen were more likely to be rehospitalized for respiratory illness (adjusted relative risk 1.33; 95% CI 1.16 to 1.53) and more likely to use respiratory medications and equipment. Rates of neurodevelopmental impairment were similar between the groups.
In this matched cohort of infants with BPD, postdischarge oxygen was associated with marginally improved growth and increased resource use but no difference in neurodevelopmental outcomes. Ongoing and future trials are critical to assess the efficacy and safety of postdischarge supplemental oxygen for infants with BPD.
比较患有支气管肺发育不良（BPD）的极早产儿在出院时通过鼻塞接受补充氧气与在出院时呼吸室内空气的呼吸疾病严重程度相似的婴儿在出生后 2 年内的医疗和发育结局。
我们进行了倾向评分匹配队列研究。符合条件的婴儿出生时胎龄<27 周，在 36 周龄时接受补充氧气或呼吸支持，在 18 至 26 个月校正年龄时进行评估。研究结局包括出院至随访期间的生长、资源利用和神经发育情况。通过多变量模型调整中心和随访时的年龄来比较结局。
共 1039 名接受补充氧气的婴儿与接受室内空气呼吸的婴儿进行了倾向评分 1:1 匹配。接受氧气治疗的婴儿在体重评分上有轻微改善（调整后的平均差异为 0.11；95%置信区间[CI]为 0.00 至 0.22），在 22 至 26 个月校正年龄时体重长度评分显著改善（调整后的平均差异为 0.13；95%CI 为 0.06 至 0.20）。接受氧气治疗的婴儿更有可能因呼吸道疾病再次住院（调整后的相对风险为 1.33；95%CI 为 1.16 至 1.53），更有可能使用呼吸药物和设备。两组的神经发育障碍发生率相似。
在这项患有 BPD 的匹配队列研究中，出院后接受氧气治疗与轻微改善的生长和增加的资源利用相关，但在神经发育结局方面无差异。正在进行和未来的试验对于评估 BPD 婴儿出院后补充氧气的疗效和安全性至关重要。
