A useful and much study needed since neonatologists and consulting pediatric pulmonologists rely on few reliable indicators to judge discharge readiness. And with little guidance, often managed care restrictions may prompt premature discharge. A baseline CO2 retention above a certain threshold always seemed like at least 1 useful measure, now supported by this South Korean study.
Children with chronic lung disease of prematurity tend to have reduced lung function, increased susceptibility to respiratory viral illness, and elevated risk for rehospitalization. Setting goals for discharge are greatly needed in this high risk population.
Capillary partial pressure of carbon dioxide for predicting rehospitalization in preterm infants under noninvasive respiratory support with severe bronchopulmonary dysplasia
Abstract
Background
The severity of bronchopulmonary dysplasia (BPD) is an important predictor of prognosis in preterm infants. However, the severity of BPD was determined mainly by the degree of oxygen supplementation and mode of respiratory support.
Objectives
This retrospective study aimed to examine the role of partial pressure of carbon dioxide (pCO2) in predicting rehospitalization among preterm infants with severe BPD without invasive ventilation at 36 weeks' postmenstrual age (PMA).
Methods
We assessed preterm infants aged <32 gestational weeks with severe BPD who were receiving noninvasive respiratory support at 36 weeks' PMA. Patients were compared after stratifying them according to the history of rehospitalization owing to respiratory infection before a corrected age (CA) of 1 year and pCO2 measured by capillary blood gas analysis at 36 weeks' PMA.
Results
Among 54 infants who had severe BPD with noninvasive respiratory support at 36 weeks' PMA, 16 (29.6%) experienced rehospitalization due to respiratory problems. At 36 weeks' PMA, the amount of oxygen supplementation (0.30 vs. 0.28, p = 0.021) and pCO2 (62.1 vs. 53.6 mmHg, p = 0.006) were higher in the rehospitalization group than in the no rehospitalization group. Multivariate logistic analysis findings indicated that pCO2 ≥ 57.4 mmHg was the only factor associated with rehospitalization (adjusted odds ratio: 8.017, 95% confidence interval 1.239–51.859).
Conclusion
High pCO2 during noninvasive respiratory support at 36 weeks' PMA in severe BPD was associated with rehospitalization. Consideration of the degree of impairment in ventilatory capacity may improve the prediction of later respiratory outcomes in infants with BPD.
Pediatric Pulmonology
December 2021
Pages 3863-3869
