Diaphragm pacing in infants and children

Area of Science:

• Pediatric Pulmonology
• Biomedical Engineering
• Neuromuscular Disorders

Background:

• Diaphragm pacing is a treatment for respiratory failure.
• Infants and children present unique challenges compared to adults for effective pacing.
• Conditions like central hypoventilation syndrome (CHS) necessitate advanced ventilatory support.

Purpose of the Study:

• To evaluate the efficacy and safety of bilateral diaphragm pacing in pediatric patients.
• To identify necessary modifications for effective ventilation in young patients.
• To assess the long-term outcomes and potential for reduced stimulation in diaphragm pacing.

Main Methods:

• Implantation of bilateral diaphragm pacers in 34 infants and children.
• Modifications for pediatric anatomy and physiology.
• Assessment of ventilation, mobility, and long-term outcomes.
• Comparison of current pacing regimes with previous ones, focusing on stimulation parameters.

Main Results:

• Effective ventilation achieved in 34 pediatric patients, including those with CHS, myelomeningocele, and quadriplegia.
• Tracheostomy was necessary due to upper airway issues.
• Bilateral pacing enabled nocturnal ventilation for CHS patients and improved mobility for others.
• No phrenic nerve damage observed after up to 10.7 years of pacing.
• Current pacing regime uses fewer stimuli per minute, suggesting long-term feasibility.

Conclusions:

• Bilateral diaphragm pacing is a viable option for pediatric respiratory failure.
• Modifications allow for effective ventilation and improved patient mobility.
• Reduced stimulation protocols show promise for long-term, continuous diaphragm pacing in children.