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Nissen Fundoplication in Infants With Severe Bronchopulmonary Dysplasia: A Propensity-Matched Analysis

Raissa Li1, Nicole M Chandler2, Aaron Germain3

  • 1Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida; Tufts University School of Medicine, Boston, Massachusetts.

The Journal of Surgical Research
|May 25, 2024
PubMed

Insights

Nissen fundoplication in premature infants with severe bronchopulmonary dysplasia (sBPD) was linked to longer hospital stays and increased resource use. Further research is needed to define its benefits and indications in this vulnerable population.

Area of Science:

  • Neonatal Medicine
  • Pediatric Surgery
  • Respiratory Medicine

Background:

  • Bronchopulmonary dysplasia (BPD) is a significant respiratory complication in premature infants.
  • Nissen fundoplication is sometimes used in infants with BPD to prevent aspiration from gastroesophageal reflux.
  • The precise indications and benefits of Nissen fundoplication in BPD remain unclear.

Purpose of the Study:

  • To evaluate the association between Nissen fundoplication and clinical outcomes in infants with severe BPD (sBPD).
  • To utilize propensity score matching to minimize bias and confounding in the analysis.

Main Methods:

  • Infants with sBPD (gestational age ≤31 weeks) admitted between January 2016 and October 2021 were included.
  • Propensity score matching (1:2 ratio) was used to compare infants who underwent Nissen fundoplication with those who did not.
  • Key outcomes assessed included time to freedom from respiratory support, time to NICU discharge, and 1-year postdischarge readmission or death.

Main Results:

  • After matching, 18 Nissen infants were compared to 30 non-Nissen infants.
  • The Nissen group showed a trend towards longer time to respiratory support freedom (105 vs. 70 days).
  • Nissen fundoplication was associated with longer initial hospital stays (188 vs. 111 days), higher 1-year readmission rates (83% vs. 50%), and increased tracheostomy use (28% vs. 0%).
  • 1-year postdischarge mortality was similar between groups (6% vs. 10%).

Conclusions:

  • Nissen fundoplication in infants with sBPD was associated with prolonged respiratory support and increased healthcare resource utilization.
  • These findings suggest caution in the use of Nissen fundoplication for sBPD without clear indications.
  • Prospective studies are necessary to establish appropriate indications and confirm the benefits of fundoplication in this patient group.
Abstract

Keywords:
Bronchopulmonary dysplasiaFundoplicationNissen

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