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Liberation from Respiratory Support in Bronchopulmonary Dysplasia
Matthew J Kielt1, Isabella Zaniletti2, Joanne M Lagatta3
1Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
The Journal of Pediatrics
|November 9, 2024
Summary
The mode of respiratory support and hospital care significantly impact liberation from respiratory support for infants with bronchopulmonary dysplasia. Different support methods at 36 weeks post-menstrual age affect recovery time.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Infants with bronchopulmonary dysplasia (BPD) often require prolonged respiratory support.
- Optimizing respiratory support strategies is crucial for improving outcomes in premature infants.
Purpose of the Study:
- To investigate the association between the type of respiratory support at 36 weeks post-menstrual age (PMA) and the time to liberation from respiratory support (LRS).
- To identify factors influencing LRS in infants with moderate to severe BPD.
Main Methods:
- Retrospective analysis of 3483 infants born <32 weeks gestation with grade 2/3 BPD from 2017-2022.
- Exposure: mode of respiratory support at 36 weeks PMA (HFNC, CPAP, NIPPV, MV).
- Outcome: time-to-LRS, analyzed using restricted mean survival time.
Main Results:
- Significant differences in median time-to-LRS were observed across support groups (HFNC: 37 weeks, CPAP: 39 weeks, NIPPV: 41 weeks, MV: 44 weeks PMA).
- A 10-fold variation in time-to-LRS was noted between centers, even after adjusting for clinical risk factors.
- 4.2% died, 7.6% survived with tracheostomy, and 7.5% were transferred.
Conclusions:
- The mode of respiratory support at 36 weeks PMA is independently associated with time-to-LRS in infants with BPD.
- The center of care also plays a significant role in the time to liberation from respiratory support, independent of patient characteristics.
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