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. 2023 May 1;151(5):e2022060651.
doi: 10.1542/peds.2022-060651.

Respiratory Outcomes for Ventilator-Dependent Children With Bronchopulmonary Dysplasia

Winston M Manimtim  1 , Amit Agarwal  2 , Stamatia Alexiou  3 , Jonathan C Levin  4 , Brianna Aoyama  5 , Eric D Austin  6 , Manvi Bansal  7 , Sarah E Bauer  8 , A Ioana Cristea  8 , Julie L Fierro  3 , Donna M Garey  9 , Lystra P Hayden  4 , Jacob A Kaslow  6 , Audrey N Miller  10 , Paul E Moore  7 , Leif D Nelin  10 , Antonia P Popova  11 , Jessica L Rice  3 , Michael C Tracy  12 , Christopher D Baker  13 , Sara K Dawson  14 , Laurie C Eldredge  15 , Khanh Lai  16 , Lawrence M Rhein  17 , Roopa Siddaiah  18 , Natalie Villafranco  19 , Sharon A McGrath-Morrow  3 , Joseph M Collaco  5
Affiliations

Respiratory Outcomes for Ventilator-Dependent Children With Bronchopulmonary Dysplasia

Winston M Manimtim et al. Pediatrics. .

Abstract

Objectives: To describe outpatient respiratory outcomes and center-level variability among children with severe bronchopulmonary dysplasia (BPD) who require tracheostomy and long-term mechanical ventilation.

Methods: Retrospective cohort of subjects with severe BPD, born between 2016 and 2021, who received tracheostomy and were discharged on home ventilator support from 12 tertiary care centers participating in the BPD Collaborative Outpatient Registry. Timing of key respiratory events including time to tracheostomy placement, initial hospital discharge, first outpatient clinic visit, liberation from the ventilator, and decannulation were assessed using Kaplan-Meier analysis. Differences between centers for the timing of events were assessed via log-rank tests.

Results: There were 155 patients who met inclusion criteria. Median age at the time of the study was 32 months. The median age of tracheostomy placement was 5 months (48 weeks' postmenstrual age). The median ages of hospital discharge and first respiratory clinic visit were 10 months and 11 months of age, respectively. During the study period, 64% of the subjects were liberated from the ventilator at a median age of 27 months and 32% were decannulated at a median age of 49 months. The median ages for all key events differed significantly by center (P ≤ .001 for all events).

Conclusions: There is wide variability in the outpatient respiratory outcomes of ventilator-dependent infants and children with severe BPD. Further studies are needed to identify the factors that contribute to variability in practice among the different BPD outpatient centers, which may include inpatient practices.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have to potential no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Age at key events (Kaplan-Meier estimates).
FIGURE 2
FIGURE 2
Subjects by center: values on the figure represent the median age at each center for key events as derived from Kaplan-Meier analysis. Not all centers have median ages for weaning from ventilator or decannulation because fewer than 50% of the subjects from those centers experienced those events. The dashed lines represent the median age for key events for the entire population. Of note, the median ages for all key events differ by center as assessed by log-rank tests (P < .001 for all events, except for weaning from ventilator, which was .001).
See this image and copyright information in PMC

References

    1. Stoll BJ, Hansen NI, Bell EF, et al. ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network . Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA. 2015;314(10):1039–1051 - PMC - PubMed
    1. Siffel C, Kistler KD, Lewis JFM, Sarda SP. Global incidence of bronchopulmonary dysplasia among extremely preterm infants: a systematic literature review. J Matern Fetal Neonatal Med. 2021; 34(11):1721–1731 - PubMed
    1. Jensen EA, Dysart K, Gantz MG, et al. . The diagnosis of bronchopulmonary dysplasia in very preterm infants. An evidence-based approach. Am J Respir Crit Care Med. 2019;200(6):751–759 - PMC - PubMed
    1. Guaman MC, Pishevar N, Abman SH, Keszler M, Truog WE, Panitch H, et al. . Invasive mechanical ventilation at 36 weeks post-menstrual age, adverse outcomes with a comparison of recent definitions of bronchopulmonary dysplasia. J Perinatol. 2021;41(8):1936–1942 - PMC - PubMed
    1. Murthy K, Porta NFM, Lagatta JM, %Zaniletti I, Truog WE, Grover TR, et al. . Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia. J Perinatol. 2017;37(6):723–727 - PubMed

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