Early inspired oxygen and intermittent hypoxemic events in extremely premature infants are associated with asthma medication use at 2 years of age

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Extremely premature infants are at risk for childhood wheezing. Early respiratory support and intermittent hypoxemia (IH) events may be associated with adverse breathing outcomes.

Study design

A single-center retrospective cohort study of 137 premature infants <28 weeks gestational age characterized the associations of cumulative oxygen, cumulative mean airway pressure, IH, and oxygen saturation (SpO2) on the primary outcome of prescription asthma medication use at 2-year follow-up. Relative risk was calculated by generalized estimating equations.


Reported asthma medication use was 46%. At 1–3 days of age, elevated cumulative oxygen exposure, increased daily IH, and lower mean SpO2 (adjusted for gestational age and sex) and increased cumulative mean airway pressure exposure (unadjusted) were associated with asthma medication use.


Increased oxygen and frequent IH events during just the first 3 days of age may help identify extremely premature newborns at risk for symptomatic childhood wheezing requiring prescription asthma medications.

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AMD was supported by the NIH T32HD060537 (PI Richard Martin) and TMR by the NIH K08HL133459-01A1. The study was also supported by NIH R01HL056470 (PI Richard Martin). The authors thank Marissa Mancuso and Dominic Camperchiolo for assisting with chart recovery and data entry. AMD and TMR are participants in the NIH Loan Repayment Program.

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Correspondence to Thomas M. Raffay.

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