Inhaled bronchodilator exposure in the management of bronchopulmonary dysplasia in hospitalized infants

OBJECTIVE: To determine clinical, demographic, and hospital factors associated with inhaled bronchodilator (IB) use in infants with bronchopulmonary dysplasia (BPD) and specifically severe BPD. STUDY DESIGN: Retrospective multicenter cohort study of 4986 infants born <32 weeks gestation with developing BPD at 28 days of life. We used the Pediatric Health Information System database to compare hospital experience and the demographic and clinical characteristics of infants exposed and not exposed to IBs. RESULTS: Twenty-five percent of BPD patients (1224/4986) and 48% of severe BPD patients (664/1390) received IBs. IB exposure was higher in infants with the tracheostomy, prolonged steroid and diuretic exposure, and longer duration of respiratory support. IB use varied markedly between hospitals (0–59%). Average annual BPD census was not associated with IB use. CONCLUSION: Bronchodilator exposure is common in BPD patients with substantial variability in its use. Hospital experience did not account for the between-hospital variation in practice.