Home Oxygen Use for Preterm Infants with Bronchopulmonary Dysplasia in California

Abstract

To identify predictors of home oxygen use in preterm infants with bronchopulmonary dysplasia (BPD) in a statewide cohort, identify hospital variation in home oxygen use, and determine the relationship between home oxygen use and neonatal intensive care unit discharge timing. This was a secondary analysis of California Perinatal Quality Care Collaborative data. Infants were born <32weeks of gestation, diagnosed with BPD based on respiratory support at 36weeks postmenstrual age (PMA), and discharged home. Risk factors for home oxygen use were identified using a logistic mixed model with center as random effect. Estimates were used to calculate each center's observed to expected ratio of home oxygen use, and a Spearman coefficient between center median PMA at discharge and observed and expected proportions of home oxygen use. Of 7846, 3672 infants (47%) with BPD were discharged with home oxygen. Higher odds of home oxygen use were seen with antenatal steroids, maternal hypertension, earlier gestational age, male sex, ductus arteriosus ligation, more ventilator days, nitric oxide, discharge from regional hospitals, and PMA at discharge (receiver operating characteristic area under the curve 0.85). Of 92 hospitals, home oxygen use ranged from 7% to 95%; 42% of observed home oxygen use was significantly higher or lower than expected given patient characteristics. The 67 community hospitals with higher observed rates of home oxygen had earlier median PMA at discharge (correlation -0.27, P=.024). Clinical and hospital factors predict home oxygen use. Home oxygen use varies across California, with community centers using more home oxygen having a shorter length of stay.