360 - Characteristics of Home Oxygen Therapy for Preterm Infants with Bronchopulmonary Dysplasia in China: Results of a Multicenter Cohort Study

Poster Number: 360
Publication Number: 360.440

Wenxing Jiang, Jiangxi Provincial Children’s Hospital, Nanchang, Jiangxi, China (People's Republic); Yanchen Wang, Children‘s Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Hongxia Song, The First Affiliated Hospital of Xian Jiaotong University, Xian, Shaanxi, China (People's Republic); Siyuan Jiang, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Yun Cao, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Wenhao Zhou, Children's Hospital, Shanghai, Shanghai, China (People's Republic); Liping Chen, Jiangxi Provincial Children’s Hospital, Nanchang, Jiangxi, China (People's Republic); Liyuan Hu, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic)

Background: Home oxygen therapy (HOT) may be needed at discharge in some very preterm infants (VPI) with severe bronchopulmonary dysplasia (BPD). However, there is a lack of evidence-based consensus on indications for HOT. Understanding HOT practices can assist us in developing optimal intervention strategies for these at-risk infants.

Objective: To characterize the use of HOT among VPIs with BPD in China.

Design/Methods: This was a secondary analysis of Chinese Neonatal Network (CHNN) data. The CHNN prospectively collected demographic and clinical data from 10,823 VPI at gestational ages < 32 weeks, and discharged from 57 tertiary hospitals located in 25 provinces. We analyzed VPI with moderate or severe BPD (defined as need for any respiratory support at a postmenstrual age (PMA) of 36 weeks) at NICU discharge from January 1, 2019 to December 31, 2019.

Results: Of 1768 preterm infants with BPD, 474 infants (26.8%) were discharged home with oxygen. Factors significantly associated with HOT were gestational age < 26 weeks at birth (adjusted odds ratio [aOR], 3.17 [1.60–6.28], p < 0.01), gestational age between 26 and 28 weeks at birth (aOR, 1.55 [1.17–2.05], p < 0.01), and those who required ≥3 doses of surfactant (aOR, 2.22 [1.14–4.32], p=0.02). Also, with each additional 7-day increase in hospital stay and need for invasive ventilation, the risk factor was increased by 0.74 (aOR, 0.74 [0.68–0.82], p < 0.01) and 1.24 (aOR, 1.24 [1.13–1.35], p < 0.01), respectively. The proportion of HOT used in participating member hospitals varied from 0% to 89%, with 5 hospitals having higher than average use of HOT, 14 hospitals with lower than average use of HOT, and 33 hospitals with average use. There was a negative correlation between use of HOT and median GDP per capita (p < 0.01).Conclusion(s): In this cohort study, the use of HOT varied across China, and was negatively correlated with the levels of economic development of the provinces. These findings suggested that a local HOT guideline is needed to address the wide variation in HOT use with respect to different regional economic levels in China.
Figure 1. Multivariate analysis of risk factors for HOTa The change trend of OR value for every 7 day of continuous variable increase.
OR, odds ratio; Ref, reference; SGA, small for gestational age; AGA, appropriate for gestational age; LGA, large for gestational age; NICU, neonatal intensive care unit; NO, nitric oxide; NEC, necrotizing enterocolitis.
Figure 2. Institutional Variation of Home Oxygen Therapy.A) The proportion of Home Oxygen Therapy in participating NICUs of the Chinese Neonatal Network. The x-axis represents the order of each NICU from the highest to the lowest proportion of HOT, and the y-axis represents the proportion of HOT in each NICU. B) The “Funnel” plot of Home Oxygen Therapy. “Funnel” plot shows observed / expected HOT (O / E) ratio in 52 hospitals discharging ≥ 5 infants with BPD. The x-axis represents the expected HOT cases in each NICU, the y-axis represents the indirectly standardized O / E ratio of each NICU, the red dotted line represents 95% control limit, and the blue solid line represents 99.8% control limit. Of the 52 NICUs, 5 and 14 hospitals exceed +95% and -95% control limit respectively.