The following is a summary of “Liberation from Respiratory Support in Bronchopulmonary Dysplasia,” published in the November 2024 issue of Pediatrics by Kielt et al.    

Infants with bronchopulmonary dysplasia (BPD) are affected by a chronic lung disease that often requires prolonged respiratory support and occurs in those born before 32 weeks’ gestation.  

Researchers conducted a retrospective study to evaluate the association between the mode of respiratory support at 36 weeks’ post-menstrual age (PMA) and time-to-liberation from respiratory support (LRS) in infants with grade 2/3 BPD.  

They reviewed daily respiratory support data from infants born before 32 weeks’ gestation who had grade 2/3 BPD and were enrolled in the Children’s Hospital’s Neonatal Database (2017 and 2022). The primary exposure was the respiratory support mode at 36 weeks’ PMA, categorized as 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, time-to-LRS, was the PMA when infants weaned to nasal cannula <2 L/min or room air for over 2 days. The independent association between support mode and time-to-LRS was estimated using restricted mean survival time analysis.  

The results showed 3,483 infants from 41 centers, 17% received HFNC, 36% received CPAP, 16% received NIPPV, and 32% received MV at 36 weeks’ PMA. After excluding infants who died (4.2%), survived with tracheostomy (7.6%), or transferred to another facility (7.5%), the median time-to-LRS differed by support mode: HFNC at 37 weeks PMA (IQR: 37, 39), CPAP at 39 weeks (IQR: 37, 41), NIPPV at 41 weeks (IQR: 39, 45), and MV at 44 weeks (IQR: 40, 48) (P<0.001). After adjusting for clinical risk factors, a 10-fold difference in time-to-LRS across centers was observed.  

They concluded that in infants with grade 2/3 BPD, the mode of respiratory support at 36 weeks’ PMA and center of care were independently associated with time-to-LRS beyond patient characteristics.  

Source: jpeds.com/article/S0022-3476(24)00493-1/abstract