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Observational Study
. 2025 Apr;60(4):e71100.
doi: 10.1002/ppul.71100.

Outcomes of Ventilator-Dependent Children With Severe Bronchopulmonary Dysplasia and Tracheobronchomalacia

Manvi Bansal  1 , Winston M Manimtim  2 , Amit Agarwal  3 , Stamatia Alexiou  4 , Jessica L Rice  4 , Leif Nelin  5 , Audrey N Miller  5 , Jonathan C Levin  6   7 , Khanh Lai  8 , Jacob A Kaslow  9 , Lystra P Hayden  6 , Julie L Fierro  4 , Anita Bhandari  4 , Eric D Austin  9 , Brianna Aoyama  10 , Gangaram Akangire  2 , Natalie Villafranco  11 , Nicole Stephenson  12 , Roopa Siddaiah  13 , Robin L McKinney  14 , Melissa A House  15 , Christopher D Baker  16 , Steven H Abman  16 , Sharon A McGrath-Morrow  4 , Joseph M Collaco  10
Affiliations
Observational Study

Outcomes of Ventilator-Dependent Children With Severe Bronchopulmonary Dysplasia and Tracheobronchomalacia

Manvi Bansal et al. Pediatr Pulmonol. 2025 Apr.

Abstract

Objectives: To characterize an observational cohort of ventilator-dependent infants and children with bronchopulmonary dysplasia (BPD) with or without tracheobronchomalacia (TBM) and determine the impact of TBM on the need for ventilator support, liberation from the ventilator and tracheostomy decannulation.

Methods: Demographics and clinical outcomes were obtained by retrospective review from 12 centers participating in the outpatient BPD Collaborative registry. The cohort consisted of infants born between 2016 and 2021 who were dependent on invasive mechanical ventilation at home. The respiratory outcomes of those infants with TBM were compared to those who did not have TBM.

Results: There were 154 subjects included and about half (48.7%) had documented TBM. Both the TBM and non-TBM groups had similar demographic characteristics and respiratory outcomes. However, the non-TBM were found to have lower mean birth weight (673 vs. 832 grams; p = 0.006), higher likelihood of having Nissen fundoplication (34.2% vs. 12.2%; p = 0.006) and higher use of diuretics (59.2% vs. 37.3%; p = 0.007). Both groups were similar in terms of ventilator requirements, timing of liberation from the ventilator, and rate of decannulation.

Conclusions: The presence of TBM in ventilator-dependent infants with BPD did not affect ventilator support needs, liberation from the ventilator and the rate of tracheostomy decannulation. We speculate that the relative contributions of the other components of BPD disease may play critical roles in determining the need for tracheostomy and their ultimate respiratory outcomes. A prospective multicenter study to assess the impact of TBM in severe BPD is urgently needed.

Keywords: bronchopulmonary dysplasia; malacia; tracheostomy; ventilator.

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