Indications for home mechanical ventilation in children: changes over four decades

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Medical Technology

Background:

• Home mechanical ventilation (HMV) has been utilized for over four decades.
• Neuromuscular disorders are the primary indication for pediatric HMV.
• Recent trends show an increasing use of HMV in younger children.

Purpose of the Study:

• To evaluate the demographics of children requiring HMV.
• To analyze changes in indications and ventilation support types over time.
• To assess trends in pediatric HMV in the Netherlands from 1979-2023.

Main Methods:

• Retrospective single-center cohort study.
• Data collected from a prospective database and medical records.
• Analysis of 544 children under 19 years initiating HMV between 1979 and 2023.

Main Results:

• The number of children starting HMV stabilized after 2017.
• Nearly 40% initiated HMV due to unplanned reasons like post-surgery or infection.
• The proportion of children under 5 years on HMV increased significantly, particularly with non-invasive ventilation (NIV).
• Neuromuscular disorders (56%) and genetic syndromes (16%) were common causes, but other diseases increased in the 21st century.

Conclusions:

• Pediatric HMV numbers are stable, but patient demographics and causes of respiratory failure have evolved.
• Non-invasive ventilation (NIV) is now the predominant mode for children initiating HMV.
• There's a notable increase in younger children, especially those using NIV, requiring HMV.