The Pandemic Allocation of Ventilators Model Penalizes Infants with Bronchopulmonary Dysplasia

Area of Science:

• Neonatal Medicine
• Critical Care
• Public Health Policy

Background:

• COVID-19 pandemic necessitated ventilator allocation models, including those for neonates.
• Proposed models assign scores based on conditions affecting mortality, potentially impacting neonates with bronchopulmonary dysplasia (BPD).
• Limited data existed on 1- and 5-year mortality risks for neonates with moderate or severe BPD (mod/sBPD).

Purpose of the Study:

• To evaluate a specific ventilator allocation model's scoring for neonates with mod/sBPD.
• To test the hypothesis that the model overestimates mortality and unfairly penalizes infants with mod/sBPD.
• To determine actual 1- and 5-year mortality rates for infants with mod/sBPD.

Main Methods:

• Retrospective chart review of infants born ≥22 weeks and weighing <1500g at Rainbow Babies and Children's Hospital in 2015.
• Identification of infants diagnosed with mod/sBPD based on the NIH 2001 definition.
• Analysis of 1- and 5-year mortality outcomes for the identified cohort.

Main Results:

• 28 infants were diagnosed with mod/sBPD (4 moderate, 24 severe).
• All infants (100%) with moderate BPD survived to 5 years.
• Infants with severe BPD showed 8% mortality by 1 year and 12.5% by 5 years, with survival rates of 92% and 54% respectively, indicating lower-than-predicted mortality.

Conclusions:

• Infants with mod/sBPD experienced lower 1- and 5-year mortality than predicted by the allocation model.
• The scoring system within the evaluated model appears to overestimate mortality risk for these infants.
• The model may unfairly penalize neonates with mod/sBPD during ventilator allocation.