Respiratory Outcomes for Ventilator-Dependent Children With Bronchopulmonary Dysplasia

Author:

Manimtim Winston M.1,Agarwal Amit2,Alexiou Stamatia3,Levin Jonathan C.4,Aoyama Brianna5,Austin Eric D.6,Bansal Manvi7,Bauer Sarah E.8,Cristea A. Ioana8,Fierro Julie L.3,Garey Donna M.9,Hayden Lystra P.4,Kaslow Jacob A.6,Miller Audrey N.10,Moore Paul E.7,Nelin Leif D.10,Popova Antonia P.11,Rice Jessica L.3,Tracy Michael C.12,Baker Christopher D.13,Dawson Sara K.14,Eldredge Laurie C.15,Lai Khanh16,Rhein Lawrence M.17,Siddaiah Roopa18,Villafranco Natalie19,McGrath-Morrow Sharon A.3,Collaco Joseph M.5

Affiliation:

1. aDivision of Neonatology, Children’s Mercy-Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, Missouri

2. bDivision of Pulmonary Medicine, Arkansas Children’s Hospital and University of Arkansas for Medical Sciences, Little Rock, Arkansas

3. cDivision of Pulmonary Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania

4. dDivision of Pulmonary Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts

5. eEudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, Maryland

6. fPulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, Tennessee

7. gPulmonology and Sleep Medicine, Children’s Hospital of Los Angeles, Los Angeles, California

8. hDivision of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children’s Hospital and Indiana University, Indianapolis, Indiana

9. iDepartment of Pediatrics, Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona

10. jDivision of Neonatology, Nationwide Children’s Hospital and Ohio State University, Columbus, Ohio

11. kPediatric Pulmonology, University of Michigan, Ann Arbor, Michigan

12. lDivision of Pediatric Pulmonary, Asthma and Sleep Medicine, Stanford University, Stanford, California

13. mSection of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado

14. nDepartment of Pediatrics, Medical College of Wisconsin Milwaukee, Wisconsin

15. oDivision of Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington

16. pDivision of Pediatric Pulmonary and Sleep Medicine, University of Utah, Salt Lake City, Utah

17. qNeonatal-Perinatal Medicine/Pediatric Pulmonology, University of Massachusetts, Worcester, Massachusetts

18. rPediatric Pulmonology, Penn State Health, Hershey Pennsylvania

19. sPulmonary Medicine, Texas Children’s Hospital and Baylor University, Houston, Texas

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.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

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