Inhaled Bronchodilator Use for Infants with Bronchopulmonary Dysplasia

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.