Introduction: Preterm children with bronchopulmonary dysplasia (BPD) frequently require supplemental oxygen in the outpatient setting. In this study, we sought to determine patient characteristics and demographics associated with need for supplemental oxygen at initial hospital discharge, timing to supplemental oxygen liberation, and associations between level of supplemental oxygen and likelihood of respiratory symptoms and acute care usage in the outpatient setting. Methods: A retrospective analysis of subjects with BPD on supplemental oxygen (O 2) was performed. Subjects were recruited from outpatient clinics at Johns Hopkins University and the Children’s Hospital of Philadelphia between 2008 and 2021. Data were obtained by chart review and caregiver questionnaires. Results: Children with BPD receiving > 1 liter of O 2 were more likely to have severe BPD, pulmonary hypertension and be older at initial hospital discharge. Children discharged on higher levels of supplemental O 2 were slower to wean to room air compared to lower O 2 groups (p<0.001). Additionally, weaning off supplemental O 2 in the outpatient setting was delayed in children with gastrostomy tubes and those prescribed inhaled corticosteroids, on public insurance or with lower estimated household incomes. Level of supplemental O 2 at discharge did not influence outpatient acute care usage or respiratory symptoms. Conclusion: BPD severity and level of supplemental oxygen use at discharge did not correlate with subsequent acute care usage or respiratory symptoms in children with BPD. Weaning of O 2 however was significantly associated with socioeconomic status and respiratory medication use, contributing to the variability in O 2 weaning in the outpatient setting.

Rationale: Bronchopulmonary dysplasia (BPD) is a major complication of premature birth and the most common cause of chronic lung disease in infancy. Previous studies have shown that children with a history of BPD have impaired lung function in childhood compared to their term counterparts. However, little is known about potential modifiable factors that alter lung function trajectories and subsequent respiratory morbidity in this population. Objectives: To identify potential modifiable risk factors for the development of impaired lung function in patients with a history of prematurity and BPD. Methods: Growth parameters (birth, 2yo, 6yo) and pulmonary function testing (6yo) were retrospectively reviewed for subjects (n=598) recruited from an outpatient BPD clinic who were born ≤36 weeks gestation and were ≥5 years of age. Results: Of the 598 recruited subjects, 88 (14.7%) performed adequate pulmonary function testing at approximately six years of age. The mean FEV1% predicted was 84.5% with lower values associated with lower median household income, Nissen fundoplication, and higher weight percentiles at 2yo. The mean FVC % predicted was 94.2% with lower values associated with higher amounts of oxygen required at time of initial hospital discharge, Nissen fundoplication, and higher weight percentiles at 2yo. Conclusions: Our study found that children with BPD have different long-term pulmonary trajectories than full-term controls. Supplemental oxygen, lower income, and Nissen fundoplication at discharge were associated with lower lung function at 6 years of age. Prospective studies should focus on modifiable risk factors that could minimize the impact of BPD on later lung function.