Abstract Rationale The pharmacologic management of severe bronchopulmonary dysplasia (sBPD) remains highly variable and largely unsupported by evidence-based guidelines. Most medications are prescribed off-label, resulting in substantial inter-center variation. While previous studies have described medication exposure during hospitalization, little is known about pharmacotherapy at the critical juncture of transitioning infants from a hospital to a portable home ventilator (PHV). Objective To describe patterns of medication use and inter-center variation among infants with sBPD at the time of transition to a PHV. A secondary objective was to explore associations between specific medication classes and successful transition. Methods This was a secondary analysis of a multicenter initiative within the BPD Collaborative aimed at identifying best practices for transitioning infants with sBPD from intensive care unit (ICU) ventilators to PMVs. Eligible infants met the 2001 NIH criteria for sBPD, had a tracheostomy, and were transitioned to home ventilator support between September 2020 and September 2022. Data from 15 centers were analyzed, each contributing an average of five patients (total n = 74). The prevalence of use across 10 medication classes was calculated for each center, and inter-center variability was visualized using a heat map. Secondary analysis explored associations between medication classes and successful transition, defined as ≥ 10 consecutive days on a PHV without return to an ICU ventilator. Results Medication use was common and heterogenous across centers. Inhaled corticosteroids (80%) and beta-agonists (73%) were most frequently prescribed, followed by diuretics (59%) and alpha-agonists (55%). Systemic corticosteroids were used in 26% of patients, while other agents varied substantially. The heat map demonstrated marked inter-center variation, with some centers showing routine use of select medications, while others reported minimal exposure. No consistent trend was observed between total medication exposure and transition success. A median of five medication classes per patient reflected the prevalence of polypharmacy. Alpha-agonist exposure was associated with lower odds of successful transition (OR 0.18;p=0.03), whereas all infants receiving systemic steroids transitioned successfully (p = 0.017). Higher postmenstrual age (61 vs. 54 weeks; p = 0.01) and greater weight (6.6 vs 5.7 kg; p = 0.03) were associated with successful transition. Conclusions Infants with sBPD transitioning to PHV receive multiple medication classes, reflecting high rates of polypharmacy and substantial inter-center variability. The limited sample size precludes definitive conclusions regarding associations between pharmacotherapy and transition success. Larger, prospective studies are needed to define evidence-based medication strategies, minimize unnecessary exposure, and optimize outcomes in this vulnerable population. This abstract is funded by: no funding
Alza’Atreh et al. (Fri,) studied this question.