Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
J Pediatr. 2022 Dec;251:105-112.e1. doi: 10.1016/j.jpeds.2022.07.040. Epub 2022 Aug 5.
To test whether prospective classification of infants with bronchopulmonary dysplasia identifies lower-risk infants for discharge with home oxygen who have fewer rehospitalizations by 1 year after neonatal intensive care unit discharge.
This is a prospective single-center cohort that included infants from 2016 to 2019 with bronchopulmonary dysplasia, defined as receiving respiratory support at 36 weeks of postmenstrual age. "Lower-risk" infants were receiving ≤2 L/min nasal cannula flow, did not have pulmonary hypertension or airway comorbidities, and had blood gas partial pressure of carbon dioxide <70 mm Hg. We compared 3 groups by discharge status: lower-risk room air, lower-risk home oxygen, and higher-risk home oxygen. The primary outcome was rehospitalization at 1 year postdischarge, and the secondary outcomes were determined by the chart review and parent questionnaire.
Among 145 infants, 32 (22%) were lower-risk discharged in room air, 49 (32%) were lower-risk using home oxygen, and 64 (44%) were higher-risk. Lower-risk infants using home oxygen had rehospitalization rates similar to those of lower-risk infants on room air (18% vs 16%, P = .75) and lower rates than higher-risk infants (39%, P = .018). Lower-risk infants using home oxygen had more specialty visits (median 10, IQR 7-14 vs median 6, IQR 3-11, P = .028) than those on room air. Classification tree analysis identified risk status as significantly associated with rehospitalization, along with distance from home to hospital, inborn, parent-reported race, and siblings in the home.
Prospectively identified lower-risk infants discharged with home oxygen had fewer rehospitalizations than higher-risk infants and used more specialty care than lower-risk infants discharged in room air.
检验前瞻性分类法对支气管肺发育不良患儿的应用效果，以明确对于接受经鼻高流量或需家庭氧疗出院的低危患儿，该方法是否能降低患儿在新生儿重症监护病房（neonatal intensive care unit，NICU）出院后 1 年的再入院率。
这是一项前瞻性单中心队列研究，纳入了 2016 年至 2019 年间因支气管肺发育不良而接受治疗的患儿，支气管肺发育不良的定义为患儿在达到校正胎龄 36 周时仍需接受呼吸支持。“低危”患儿需接受的经鼻高流量或氧疗流量不超过 2 L/min，不存在肺动脉高压或气道合并症，且其二氧化碳血气分压<70mmHg。我们根据出院状态将患儿分为 3 组：低危室内空气组、低危家庭氧疗组和高危家庭氧疗组。主要结局为出院后 1 年的再入院率，次要结局通过图表审查和家长问卷调查来确定。
在 145 名患儿中，32 名（22%）低危患儿在室内空气环境中出院，49 名（32%）低危患儿接受家庭氧疗，64 名（44%）高危患儿接受家庭氧疗。接受家庭氧疗的低危患儿的再入院率与在室内空气环境中出院的低危患儿相似（18% vs 16%，P=0.75），且低于高危患儿（39%，P=0.018）。接受家庭氧疗的低危患儿接受专科就诊的次数更多（中位数 10 次，四分位距 714 次 vs 中位数 6 次，四分位距 311 次，P=0.028）。分类树分析表明，风险状况与再入院显著相关，此外还与患儿家庭至医院的距离、是否为经阴道分娩、家长报告的种族以及家中是否有兄弟姐妹相关。
前瞻性确定的接受家庭氧疗出院的低危患儿再入院率低于高危患儿，且与在室内空气环境中出院的低危患儿相比，其接受专科就诊的次数更多。
