Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Medicine

Background:

• Severe bronchopulmonary dysplasia (sBPD) is a significant challenge in neonatal care.
• Inter-center variation (ICV) in outcomes for infants with sBPD has been observed but not fully explained.

Purpose of the Study:

• To estimate the presence and sources of inter-center variation (ICV) in the risk of death or tracheostomy placement (D/T) among infants with sBPD.
• To investigate whether specific diagnoses or practices explain the observed ICV in D/T.

Main Methods:

• Analysis of the Children's Hospitals Neonatal Database (2010-2013).
• Inclusion of referred infants born <32 weeks' gestation with sBPD.
• Multivariable modeling to assess the association between center and D/T, including hypothesized diagnoses/practices.

Main Results:

• D/T occurred in 20% of 1383 eligible infants across 21 centers.
• Significant ICV was found for D/T (2-46% by center) and tracheostomy placement (2-37%), but not for death alone.
• Multivariable analysis confirmed persistent ICV, with center-specific odds ratios for D/T varying 5.5-fold.

Conclusions:

• Significant inter-center variation in death or tracheostomy placement exists for infants with severe bronchopulmonary dysplasia.
• The findings underscore uncertainty regarding indications for tracheostomy and subsequent chronic ventilation, contributing to outcome disparities.