Respiratory Outcomes for Ventilator-Dependent Children With Bronchopulmonary Dysplasia.

May 01, 2023

Experts: Winston M Manimtim,Amit Agarwal,Stamatia Alexiou,Jonathan C Levin,Brianna Aoyama,Eric D Austin,Manvi Bansal,Sarah E Bauer,A Ioana Cristea,Julie L Fierro,Donna M Garey,Lystra P Hayden,Jacob A Kaslow,Audrey N Miller,Paul E Moore,Leif D Nelin,Antonia P Popova,Jessica L Rice,Michael C Tracy,Christopher D Baker,Sara K Dawson,Laurie C Eldredge,Khanh Lai,Lawrence M Rhein,Roopa Siddaiah,Natalie Villafranco,Sharon A McGrath-Morrow,Joseph M Collaco

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

Copyright © 2023 by the American Academy of Pediatrics.

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ABOUT THE EXPERTS

Winston M Manimtim,Amit Agarwal,Stamatia Alexiou,Jonathan C Levin,Brianna Aoyama,Eric D Austin,Manvi Bansal,Sarah E Bauer,A Ioana Cristea,Julie L Fierro,Donna M Garey,Lystra P Hayden,Jacob A Kaslow,Audrey N Miller,Paul E Moore,Leif D Nelin,Antonia P Popova,Jessica L Rice,Michael C Tracy,Christopher D Baker,Sara K Dawson,Laurie C Eldredge,Khanh Lai,Lawrence M Rhein,Roopa Siddaiah,Natalie Villafranco,Sharon A McGrath-Morrow,Joseph M Collaco

Winston M Manimtim

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

Amit Agarwal

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

Stamatia Alexiou

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

Jonathan C Levin

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

Brianna Aoyama

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

Eric D Austin

Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, Tennessee.

Manvi Bansal

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

Sarah E Bauer

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

A Ioana Cristea

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

Julie L Fierro

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

Donna M Garey

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

Lystra P Hayden

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

Jacob A Kaslow

Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, Tennessee.

Audrey N Miller

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

Paul E Moore

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

Leif D Nelin

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

Antonia P Popova

Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan.

Jessica L Rice

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

Michael C Tracy

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

Christopher D Baker

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

Sara K Dawson

Department of Pediatrics, Medical College of Wisconsin Milwaukee, Wisconsin.

Laurie C Eldredge

Division of Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington.

Khanh Lai

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

Lawrence M Rhein

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

Roopa Siddaiah

Pediatric Pulmonology, Penn State Health, Hershey Pennsylvania.

Natalie Villafranco

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

Sharon A McGrath-Morrow

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

Joseph M Collaco

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