Healthcare utilisation and cost of care at school age related to home oxygen status during infancy

Abstract

Aims To determine in prematurely born children who had bronchopulmonary dysplasia (BPD), if respiratory morbidity, lung function, healthcare utilisation and cost of care at school age were influenced by a requirement for supplementary oxygen at home after discharge from the neonatal intensive care unit (NICU). Methods One hundred and sixty children, median gestational age 27 (range 22–31) weeks, cared for on four tertiary neonatal intensive care units were examined. Sixty five of them had received supplementary oxygen when discharged home from the NICU (home oxygen group). A parent completed respiratory questionnaire was administered and lung function measurements (including assessment of bronchial hyper-responsiveness) were undertaken when the children were eight years old. Healthcare utilisation during years five to seven was assessed by examining hospital and general practitioner records to identify all hospital admissions, out-patient and general practitioner attendances and medication prescribed; whether the healthcare utilisation was related to respiratory problems was noted. The cost of care was calculated using the National Scheme of Reference Costs (2003) and medication costs calculated using the British National Formulary prices. Results No child was oxygen dependent at school age. There were no significant differences in cough or wheeze or in the baseline lung function results between the two groups, but there was tendency for more of the home oxygen group to respond to a cold air challenge (p=0.0596). The home oxygen group had more out-patient attendances (p=0.0168), particularly for respiratory related problems (p=0.0032), with greater associated costs of care (p=0.0186, p=0.0030 respectively). In addition, their cost of care for prescriptions (p=0.0409) and total respiratory related cost of care (p=0.0354) were significantly greater that that of the non-home oxygen group. Conclusion Children with BPD who required supplementary oxygen at home after discharge from the NICU have increased healthcare utilisation and associated cost of care at school age. These results emphasise such prematurely born children need ongoing follow up beyond when they cease to require home oxygen.