Rationale: Extremely preterm infants are at highest risk for developing bronchopulmonary dysplasia (BPD). This study aimed to examine the relationship between gestational age and respiratory outcomes in children with BPD in the outpatient setting. Methods: Data were collected from 1,025 preterm children with BPD recruited from outpatient bronchopulmonary (BPD) clinics at Johns Hopkins and Children’s Hospital of Philadelphia (CHOP). Extremely preterm children (22-24 and 25-27 weeks gestation) were compared to a reference group of very preterm children (28 to 32 weeks gestation). Data were analyzed using Chi-square tests, t-tests, and ANOVA tests. Results: Infants born at <25 weeks gestation were more likely to have severe BPD (71.9%), be discharged on supplemental oxygen (50.7%), have public insurance, and self-report as Black (60.4%) compared to those born >25 weeks. In the outpatient setting, extremely preterm children (22-24 weeks gestation) had a higher likelihood of activity limitation (OR 1.72) compared to very preterm infants. Hispanic children, regardless of gestational age, were more likely to have sick visits (OR 2.09) and a hospital admission (OR 2.15) compared to non-Hispanic children. Children with public insurance had a higher likelihood of ED visits (OR 1.48), hospital admissions (OR 1.49), systemic steroid use (OR 1.39), nighttime respiratory symptoms (OR 1.66), and activity limitations (OR 1.61) compared to privately insured children. Conclusions: After initial hospital discharge, extremely preterm children (22-24 weeks gestation) have a higher likelihood of activity limitation. However, other factors including race/ethnicity and public insurance are more likely driving outpatient respiratory outcomes regardless of gestational age.

Rationale: In the outpatient setting, inhaled corticosteroids (ICS) are frequently given to children with bronchopulmonary dysplasia (BPD) for treatment of respiratory and asthma associated symptoms. In this study we sought to determine if correlations existed between ICS use and ICS initiation and patient characteristics and outpatient respiratory outcomes. Methods: This study included children with the diagnosis of BPD (n=661) who were seen in outpatient pulmonary clinics at the Children’s Hospital of Philadelphia between 2016-2021. Chart review was used to determine patient demographics, use and timing of ICS initiation, asthma diagnosis and acute care usage following initial hospital discharge. Results: At the first pulmonary visit, 9.2% of children had been prescribed an ICS at NICU discharge, 13.9% had been prescribed an ICS after NICU discharge but before their first pulmonary appointment, and 6.9% were prescribed an ICS at completion of initial pulmonary visit. Children started on an ICS as outpatients, had a higher likelihood of ER visits (adjusted OR: 2.68 ±0.7), hospitalizations (4.81 ± 1.16) and a diagnosis of asthma (3.58 ± 0.84), compared to children never on an ICS. Of those diagnosed with asthma, children prescribed an ICS in the outpatient setting received the diagnosis at an earlier age. No associations between NICU BPD severity scores and ICS use were found. Conclusions: This study identifies an outpatient BPD phenotype associated with ICS use and ICS initiation independent of NICU severity score. Additionally, outpatient ICS initiation correlates with a subsequent diagnosis of asthma and acute care usage in children with BPD.