Transition off respiratory support for very preterm infants with bronchopulmonary dysplasia: an observational study of national audit data in England and Wales.

Objective: To compare the proportion of infants receiving different respiratory support types between 36 and 40 weeks postmenstrual age (PMA).

Design: Retrospective cohort study using National Neonatal Audit Programme data.

Setting: England and Wales.

Patients: 50 628 infants born <32 weeks of gestation admitted to neonatal units from 2017 to 2023.

Interventions: Not applicable.

Main outcome measures: Respiratory support received and mortality.

Results: The proportion of infants who died increased at 36 weeks (8.1% to 8.6%, p=0.01) and 40 weeks (8.4% to 8.9%, p=0.01) PMA, respectively. This trend was driven by infants born <24 weeks of gestation. In survivors, those receiving any respiratory support or respiratory pressure support at 36 and 40 weeks PMA increased between 2017 and 2023 (p<0.0001). Over the study period, more infants received non-invasive ventilation at 36 weeks PMA (12.6% to 15.1%, p=0.0001) and supplemental oxygen at 40 weeks PMA (12.4% to 13.1%, p=0.002). Between 36 and 40 weeks PMA, there were absolute reductions of 11.8% and 10.6% in the proportion of surviving infants receiving any respiratory support and respiratory pressure support, respectively. This is especially so in infants born between 24 and 27 weeks of gestation, with absolute reductions of 21.3% and 24.2%, respectively.

Conclusions: More surviving preterm infants are receiving respiratory support at 36 and 40 weeks PMA. However, a large proportion of infants born 24-27 weeks of gestation transition to no respiratory support during this period. Strategies to identify infants likely to wean off respiratory support could help safely transition them home at the right time or better plan respiratory support at discharge.