281 - Effects of Neonatal Resuscitation Program Oxygen Initiation Guidelines On Bronchopulmonary Dysplasia

Jason Lin, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Sepideh Saroukhani, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Laith Enani, McGovern Medical School at the University of Texas Health Science Center at Houston, Honolulu, HI, United States; Meghan Hunt, UT Health Houston, Houston, TX, United States; Nivedha Loganathan, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Tina O. Findley, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Thu Tran, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States

Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects premature newborns. Oxygen (O2) administration induces oxidative stress and inflammation, contributing to BPD risk. The Neonatal Resuscitation Program (NRP) has gradually lowered the recommended fraction of inspired O2 (FiO2) during delivery room resuscitation, from 100% O2 (high) to 30-100% (moderate) in 2010 to 21-30% (low) in 2015. The effect of NRP guideline changes on the incidence of BPD is relatively unexplored.

Objective: To determine if decreasing FiO2 during delivery room resuscitation has decreased the incidence and severity of BPD in extremely premature infants born ≤28 weeks’ gestational age (GA).

Design/Methods: All premature infants born ≤28 weeks GA and hospitalized at a Level IV Neonatal Intensive Care Unit (NICU) between 2008 and 2023 were considered for inclusion (n=1250). Infants born in 2011 or 2016 (wash-out period) or with indeterminate BPD status at 36 weeks’ postmenstrual age (PMA) based on Jensen criteria were excluded from analysis. Included infants were stratified into one of three cohorts based on their birth year: high O2= before 2010; moderate O2= 2012-2015; and low O2=2017-2023. Maternal pregnancy history, comorbidities of prematurity, and respiratory data were collected for each infant. Analysis was performed using multinomial logistic regression.

Results: A total of 538 subjects were included in the high (n=168), moderate (n=169), and low cohorts (n=201). After adjusting for surfactant use, GA, and postnatal steroid administration, the incidence of extremely premature infants without BPD decreased from the high to low O2 cohorts (33.3% vs. 24.9%, p=0.01). The incidence of moderate BPD increased from the high to low O2 cohorts (12.5% vs. 21.9%, p=0.02). The incidence of severe or mild BPD development did not change significantly between the three cohorts. Additionally, the incidence of intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC) increased from the high to low O2 cohort (30.4% vs. 17.9% in IVH, 45.8% vs. 29.3% in NEC, p < 0.001). The incidence of retinopathy of prematurity (ROP) decreased from the high to low O2 cohort (66.1% vs. 53.2%, p = 0.02).

Conclusion(s): Decreasing FiO2 during delivery resuscitation in the NRP guidelines were associated with an overall decreased incidence of extremely premature infants without BPD and increased incidence of moderate BPD at 36 weeks’ PMA. These changes were also associated with increased incidences of NEC and IVH and decreased incidence of ROP.