530 - Diuretic Use and Duration of Home Oxygen Therapy in Preterm Infants: Insights from the Implementation of the Recorded Home Oximetry (RHO) Program

Publication Number: 3511.530

Heather White, UMass Memorial Children's Medical Center, Worcester, MA, United States; Madeline E. French, University of Massachusetts Chan Medical School, Boston, MA, United States; Lawrence Rhein, University of Massachusetts Medical School, Waban, MA, United States

Background: Preterm infants diagnosed with bronchopulmonary dysplasia (BPD) are frequently prescribed diuretics before discharge from the neonatal intensive care unit (NICU). Diuretic therapy is often continued in the outpatient setting, although recent guidelines do not recommend routine use. Additionally, evidence supporting their efficacy in decreasing both the length of stay (LOS) in the NICU and the duration of home oxygen therapy (HOT) is limited.

Objective: To evaluate the association between diuretic use and the duration of HOT in a large cohort of preterm infants requiring supplemental oxygen after neonatal intensive care unit discharge.

Design/Methods: This was a retrospective analysis of preterm infants discharged on HOT from sites participating in the multi-center implementation of the RHO Program. Infants were categorized as receiving diuretics or not at the time of discharge from the NICU. Duration of HOT (days from discharge to successful HOT discontinuation) and NICU length of stay (LOS) were compared between groups using two-sample t-tests, stratified by RHO participation.

Results: A total of 646 infants were assessed for eligibility; of these, 187 infants had data on NICU LOS, diuretic use, and oxygen duration available. Of the infants followed by RHO (146 total), the mean LOS was 122.1 +/- 65.8 days without diuretics (n = 76) and 123.3 +/- 31.1 days with diuretics (n = 70; p = 0.29). Among infants not followed by RHO, the mean LOS was 141.2 +/- 85.4 days without diuretics (n = 28) and 125.8  34.8 days for those with diuretics (n = 13; p = 0.54). Of the infants followed by RHO (144 total), the mean HOT duration was 89.7  80.7 days without diuretics (n = 74) and 82.1  91.5 days with diuretics (n = 70; p = 0.58). Among infants not followed by RHO, the mean HOT duration was 118  103 days without diuretics (n = 27) and 150  128 days for those with diuretics (n = 10; p = 0.52).

Conclusion(s): Diuretic use was not associated with earlier NICU discharge or shorter duration of HOT for infants diagnosed with BPD, and in infants not followed by the RHO program, it trended toward longer oxygen courses. These findings challenge the assumption that diuretic therapy facilitates earlier discontinuation of respiratory support in infants with BPD and highlight that standardized, data-driven weaning protocols, such as the RHO Program, may play a larger role in optimizing outpatient management.

Duration of Home Oxygen Therapy (HOT) by Diuretic Use and RHO Participation
Comparing duration of home oxygen therapy by diuretic use at time of NICU discharge and RHO Program participation