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      Inhaled Bronchodilator Use for Infants with Bronchopulmonary Dysplasia

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          Abstract

          Objective

          To identify factors associated with bronchodilator administration to infants with bronchopulmonary dysplasia (BPD) and evaluate inter-institutional prescribing patterns.

          Study Design

          A retrospective cohort study of <29-week-gestation infants with evolving BPD defined at age 28 days within the Pediatric Health Information System database. Controlling for observed confounding with random-effects logistic regression, we determined demographic and clinical variables associated with bronchodilator use and evaluated between-hospital variation.

          Result

          During the study period, 33% ( N=469) of 1429 infants with BPD received bronchodilators. Lengthening mechanical ventilation duration increased the odds of receiving a bronchodilator [OR 19.6(11–34.8) at ≥54 days]. There was profound between-hospital variation in use, ranging from 0–81%.

          Conclusion

          Bronchodilators are frequently administered to infants with BPD at U.S. children’s hospitals with increasing use during the first hospital month. Increasing positive pressure exposure best predicts bronchodilator use. Frequency and treatment duration vary markedly by institution even after adjustment for confounding variables.

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          Most cited references15

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          Statement on the care of the child with chronic lung disease of infancy and childhood.

          Robert Zwerdling, Robert Geggel, Anne Greenough … (2003)
          Article 0 comments Cited 60 times – based on 0 reviews     Review now
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            Variation in the use of diuretic therapy for infants with bronchopulmonary dysplasia.

            Michael R. Stenger, Jonathan Slaughter, Patricia B. Reagan (2013)
            To determine (1) between-hospital variation in diuretic use for infants with bronchopulmonary dysplasia (BPD), including hospital-specific treatment frequency, treatment duration, and percentage of infants receiving short (≤5 consecutive days) versus longer (>5 days) courses, and to determine (2) demographic and clinical variables associated with diuretic administration. A retrospective cohort study was conducted with the use of the Pediatric Health Information System to determine between-hospital variation in diuretic utilization patterns (primary outcome) and variables associated with diuretic use among 5 consecutive days. Furosemide was the most widely prescribed diuretic (1218 infants; 85%), although chlorothiazide had the longest median duration of use (21 days; 25th-75th percentile: 8-46 days). The range of infants receiving a diuretic course of >5 days duration varied by hospital from 4% to 86%, with wide between-hospital variation even after adjustment for confounding variables. The frequency of diuretic administration to infants with BPD at US children's hospitals, as well as the specific diuretic regimen used, varies markedly by institution. Safety and effectiveness research of long-term diuretic therapy for BPD patients is needed to develop evidence-based recommendations.
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              Early onset of airway reactivity in premature infants with bronchopulmonary dysplasia.

              E K Motoyama, M D Fort, K Klesh … (1987)
              Pulmonary function during the early development of bronchopulmonary dysplasia (BPD) in premature infants is not well understood. Furthermore, it is not known how early airway reactivity appears in BPD. During a 14-month period we studied 32 infants (mean gestational age, 27.3 wk; mean birth weight, 1.02 kg) with respiratory distress syndrome in whom BPD eventually developed. We obtained maximal expiratory flow-volume (MEFV) curves by manual inflation of the lung followed by forced deflation with a negative pressure on 64 occasions (mean postnatal age, 43.1 days). At each test MEFV curves were obtained in 3 conditions: baseline; after normal saline aerosolization with manual ventilation as a control; and after bronchodilator. Maximal expiratory flow at 25% of FVC (Vmax25) was markedly decreased at baseline and remained decreased after saline control. The FVC also was decreased in both baseline and saline control studies. After bronchodilator there was a marked (p less than 0.001) increase in Vmax25 (+214% above saline control) together with a significant (p less than 0.001) increase in FVC (+21%). Of 23 infants studied after 3 wk of postnatal age, 21 exhibited a more than 30% increase in Vmax25 above control (defined as airway reactivity). The remaining 2 infants were already receiving bronchodilator therapy. The most premature infant with demonstrable airway reactivity was 26 wk postconception, and the youngest was 12 days old. In 13 infants who were studied initially before 3 wk of age, there was a highly significant correlation (r = 0.91 p less than 0.001) between the degree of airway reactivity and the severity of respiratory disease as determined by the duration of ventilator dependence. Airway reactivity may play an important role in the development and severity of BPD.
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                Author and article information

                Journal
                Journal ID (nlm-journal-id): 8501884
                Journal ID (pubmed-jr-id): 5061
                Journal ID (nlm-ta): J Perinatol
                Journal ID (iso-abbrev): J Perinatol
                Title: Journal of perinatology : official journal of the California Perinatal Association
                ISSN (Print): 0743-8346
                ISSN (Electronic): 1476-5543
                Publication date Nihms-submitted: 23 June 2014
                Publication date (Electronic): 07 August 2014
                Publication date (Print): January 2015
                Publication date PMC-release: 01 July 2015
                Volume: 35
                Issue: 1
                Pages: 61-66
                Affiliations
                [1 ]The Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, OH 43205
                [2 ]The Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205
                [3 ]The Neonatal and Infant Feeding Disorders Research Program, Nationwide Children’s Hospital, Columbus, OH 43205
                [4 ]The Department of Economics, The Ohio State University, Columbus, OH 43210
                [5 ]Center for Human Resource Research, The Ohio State University, Columbus, OH 43210
                Author notes
                Corresponding Author: Jonathan L Slaughter, MD, MPH, Nationwide Children’s Hospital, Center for Perinatal Research, Research 3 Building, 700 Children’s Drive, Columbus, OH 43205, Telephone: (614) 355-6624; Fax: (614) 355-5899, Jonathan.Slaughter@ 123456nationwidechildrens.org
                Article
                Manuscript ID: NIHMS605960
                DOI: 10.1038/jp.2014.141
                PMC ID: 4281278
                PubMed ID: 25102319
                SO-VID: 48f4e6e7-8eef-4078-aaba-149d60322f41
                History
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                Subject: Article

                ScienceOpen disciplines: Pediatrics
                Keywords: bronchopulmonary dysplasia,prematurity,bronchodilators,short acting beta-2-adrenergic receptor agonist,nonspecific muscarinic receptor antagonist,salbutamol,albuterol,ipratropium bromide,pharmacoepidemiology,drug utilization,comparative effectiveness,practice variation,patient-centered outcomes
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                ScienceOpen disciplines: Pediatrics
                Keywords: bronchopulmonary dysplasia, prematurity, bronchodilators, short acting beta-2-adrenergic receptor agonist, nonspecific muscarinic receptor antagonist, salbutamol, albuterol, ipratropium bromide, pharmacoepidemiology, drug utilization, comparative effectiveness, practice variation, patient-centered outcomes

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