Retrospective analysis of inpatient polysomnogram characteristics and discharge outcomes in infants with bronchopulmonary dysplasia requiring home oxygen therapy
| Autor: | Sally L. Davidson Ward, Cheryl D. Lew, Noah Wright, Theodora A. Stavroudis, Choo Phei Wee, Nicole Flores-Fenlon, Manvi Bansal |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Pediatrics medicine.medical_specialty Polysomnography medicine.medical_treatment Gestational Age Infant Premature Diseases Article law.invention 03 medical and health sciences 0302 clinical medicine Interquartile range law 030225 pediatrics Oxygen therapy mental disorders Humans Medicine Oximetry Sleep study Hypoxia Bronchopulmonary Dysplasia Retrospective Studies Oxygen saturation (medicine) Inpatients medicine.diagnostic_test business.industry Infant Newborn Oxygen Inhalation Therapy Infant Gestational age Infant Low Birth Weight medicine.disease Intensive care unit Patient Discharge Oxygen 030228 respiratory system Bronchopulmonary dysplasia Pediatrics Perinatology and Child Health Disease Progression Female business Infant Premature |
| Zdroj: | Pediatr Pulmonol |
| ISSN: | 1099-0496 8755-6863 |
| Popis: | Rationale Little is known about the polysomnogram (PSG) characteristics in infants with bronchopulmonary dysplasia (BPD), especially severe BPD, who do not need home ventilatory support but are at increased risk for chronic hypoxia and are vulnerable to its effects. Objective This study aims to assess PSG characteristics and change in discharge outcomes in premature infants with BPD who required oxygen therapy at discharge. Methods This is a retrospective chart review of premature infants with BPD who were admitted to a quaternary newborn and infant intensive care unit from January 1, 2012 to December 31, 2015 and who underwent polysomnography before discharge. Measurements and main results Data from 127 patients were analyzed. The median gestational age of our patients was 26 weeks and 1 day (interquartile range [IQR]: 24.71, 28.86). The majority of the patients had moderate-to-severe BPD. The median obstructive apnea-hypopnea index was 5.3 events/h (IQR: 2.2, 10.1). The median oxygen desaturation index was 15.7 events/h (IQR: 4.7, 35). Nadir oxygen saturation measured by pulse oximeter was 81% (IQR: 76-86) and the arousal/awakening index was 21.9 (IQR: 13.3-30.9). No statistically significant difference was noted between severe and nonsevere BPD groups for PSG characteristics. However, average end-tidal CO2 was significantly higher in the severe BPD group (p = .0438). Infants in the severe BPD group were intubated longer than infants with nonsevere BPD (p = .0082). The corrected gestational age (CGA) at the time of discharge (CGA-PSG) and PSG (CGA-DC) was higher in severe BPD patients but not statistically different. The majority of premature infants who underwent a PSG were discharged home with oxygen, and 69% required a titration of their level of support based on results from the PSG. Conclusion Our results highlight the presence of abnormal PSG characteristics in BPD patients, as early as 43 weeks CGA. These findings have not been previously described in this patient population prior to initial discharge from the hospital. A severe BPD phenotype tends to be associated with higher respiratory morbidity compared with a nonsevere BPD phenotype for the comparable CGA. PSG, when available, may be helpful for individualizing and streamlining treatment in preparation for discharge home and mitigating the effects of intermittent hypoxic episodes. |
| Databáze: | OpenAIRE |
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