Liberation from Respiratory Support in Bronchopulmonary Dysplasia

Abstract

Objective: To estimate the association between the mode of respiratory support administered at 36 weeks' post-menstrual age (PMA) with time-to-liberation from respiratory support (LRS) in infants with grade 2/3 bronchopulmonary dysplasia (BPD).

Study design: Daily respiratory support data were abstracted for infants born <32 weeks' gestation with grade 2/3 BPD enrolled in the Children's Hospital's Neonatal Database between 2017 and 2022. The main exposure was the mode of respiratory support received at 36 weeks' PMA: high-flow nasal cannula >2 L/min (HFNC), continuous positive airway pressure (CPAP), non-invasive positive pressure ventilation (NIPPV), or mechanical ventilation (MV). The primary outcome was time-to-LRS, defined as the PMA when infants weaned to nasal cannula <2 L/min or room air for >2 days. The independent association between the main exposure and time-to-LRS was estimated using restricted mean survival time analysis.

Results: Among 3483 included infants from 41 centers, 17% received HFNC, 36% CPAP, 16% NIPPV, and 32% MV at 36 weeks' PMA. After censoring those who died (4.2%), survived with tracheostomy (7.6%), or were transferred to another facility (7.5%), the median (IQR) time-to-LRS differed between groups: HFNC 37 [37, 39]; CPAP 39 [37, 41] NIPPV 41[39, 45]; and MV 44 [40, 48] weeks' PMA (P < .001). Across centers, a 10-fold difference in time-to-LRS was observed after adjustment for clinical risk factors.

Conclusions: For infants with grade 2/3 BPD, the mode of respiratory support prescribed at 36 weeks' PMA and center of care were each associated with time-to-LRS independent of patient and clinical characteristics.

Keywords: mechanical ventilation; neonatal intensive care; neonate; pediatric critical care; tracheostomy.