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Changes in the patterns of respiratory support and incidence of bronchopulmonary dysplasia; a single center
Saleh S Algarni1,2,3, Kamal Ali4, Saif Alsaif4
1Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Qarnis@ksau-hs.edu.sa.
Insights
The use of heated humidified high-flow nasal cannula (HHHFNC) is rising in extremely preterm infants. Longer HHHFNC duration is significantly associated with developing bronchopulmonary dysplasia (BPD) in this vulnerable population.
Area of Science:
- Neonatal intensive care
- Pediatric respiratory medicine
- Perinatology
Background:
- Survival rates for extremely preterm infants (<29 weeks gestation) are increasing due to advances in neonatal care.
- Bronchopulmonary dysplasia (BPD) remains a significant cause of morbidity in this population.
- Understanding the impact of respiratory support modalities on BPD is crucial.
Purpose of the Study:
- To examine trends in respiratory support modalities, specifically heated humidified high-flow nasal cannula (HHHFNC).
- To investigate the association between HHHFNC use and the incidence of BPD in extremely preterm infants.
- To analyze the relationship between the duration of HHHFNC therapy and BPD severity.
Main Methods:
- Population-based retrospective cohort study of infants born <29 weeks gestation (2016-2020).
- Collected data on respiratory support: mechanical ventilation, CPAP, HHHFNC, and low-flow oxygen.
- Performed trend analysis and logistic regression to assess HHHFNC association with BPD incidence and severity.
Main Results:
- HHHFNC use and duration increased during the study period.
- Overall BPD incidence was 49% with no significant trend.
- Infants receiving HHHFNC had higher rates of any BPD (52% vs. 39%) and grades 1 & 2 BPD, but lower rates of grade 3 BPD.
- Duration of HHHFNC therapy significantly predicted BPD incidence (OR 1.04).
Conclusions:
- HHHFNC use is increasing among extremely preterm infants.
- A significant association exists between the duration of HHHFNC therapy and the development of BPD in this population.
Background:
With the advances in neonatal intensive care, the survival rate of extremely preterm infants is increasing. However, bronchopulmonary dysplasia (BPD) remains a major cause of morbidity among infants in this group. This study examined the changes in respiratory support modalities, specifically heated humidified high-flow nasal cannula (HHHFNC), and their association with BPD incidence among preterm infants born at < 29 weeks of gestation.
Method:
This population-based retrospective cohort study included infants born at < 29 weeks of gestation between 2016 and 2020. Data regarding the use and duration of respiratory support modalities were obtained, including mechanical ventilation, continuous positive airway pressure, HHHFNC, and low-flow oxygen therapy. Additionally, the incidence of BPD was determined in the included infants. Trend analysis for each respiratory support modality and BPD incidence rate was performed to define the temporal changes associated with changes in BPD rates. In addition, a logistic regression model was developed to identify the association between BPD and severity grade using HHHFNC.
Results:
Three Hundred and sixteen infants were included in this study. The use and duration of HHHFNC therapy increased during the study period. Throughout the study period, the overall incidence of BPD was 49%, with no significant trends. The BPD rate was significantly higher in the infants who received HHHFNC than in those who did not (52% vs. 39%, P = 0.03). Analysis of BPD severity grades showed that both grade 1 BPD (34% vs. 21%, P = 0.03) and grade 2 BPD (12% vs. 1%, P < 0.01) were significantly more common among infants who received HHHFNC than among those who did not. In contrast, the incidence of grade 3 BPD was lower in infants who received HHFNC (6% vs. 17%, P < 0.01). The duration in days of HHHFNC was found to significantly predict BPD incidence (OR 1.04 [95%CI: 1.01-1.06], P < 0.01) after adjusting for confounding variables.
Conclusion:
The use of HHHFNC in extremely preterm infants born at < 29 weeks of gestation is increasing. There was a significant association between the duration of HHHFNC therapy and the development of BPD in extremely preterm infants born at < 29 weeks of gestation.
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