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[Bronchopulmonary dysplasia: outcome and treatment of severe forms]
C Hermabessière1, B Monier, C Gaultier
1Centre thérapeutique pédiatrique de Margency, France.
Insights
Severe bronchopulmonary dysplasia (BPD) in infants requires prolonged respiratory and nutritional support for recovery. Infants on mechanical ventilation (MV) with low dynamic compliance (Cl dyn) need extended support, with weaning delayed until ventilatory work decreases.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Context:
- Severe bronchopulmonary dysplasia (BPD) poses challenges in managing infants requiring prolonged mechanical ventilation (MV) or oxygen therapy (O2).
- Limited data exists on the long-term outcomes and treatment guidance for infants with severe BPD.
- Understanding factors influencing recovery is crucial for optimizing care.
Purpose:
- To evaluate the outcome of severe BPD in infants dependent on MV and/or O2.
- To identify factors guiding treatment and predict the need for prolonged respiratory support.
- To assess the relationship between respiratory parameters and long-term outcomes.
Summary:
- Retrospective review of 49 infants with BPD requiring MV/O2 beyond 12 months.
- Infants on MV showed lower pulmonary dynamic compliance (Cl dyn < 50%) and increased ventilatory work compared to those on O2.
- Despite initial challenges like hypoxemia and failure to thrive, all infants achieved favorable outcomes, weaning from support between 2-4 years.
Impact:
- Prolonged respiratory and nutritional support can facilitate recovery from severe BPD in preterm infants.
- Pulmonary dynamic compliance < 50% indicates a need for extended MV.
- Weaning from MV should be deferred if increased ventilatory work persists, guiding clinical management.
Background:
The outcome of severe forms of bronchopulmonary dysplasia (BPD) leading to a prolonged dependence on mechanical ventilation (MV) and/or oxygen therapy (O2) is not evaluated, and factors of guidance to treatment are not established.
Population And Methods:
The medical records of 49 infants, born between 1982 and 1990, with BPD who required MV and or O2 after 12 months of life were retrospectively reviewed. Three groups of infants were defined: group I: 26 infants on MV since birth; group II: seven infants weaned from MV after the first month of life then put back on MV belatedly; group III: 16 infants on spontaneous ventilation (SV) under O2.
Results:
At 12 months of age, the 49 infants showed sleep hypoxemia, failure to thrive and 28% of them pulmonary hypertension. Comparison between MV and O2 infants indicated that subjects on MV had pulmonary dynamic compliance (Cl dyn) lower than 50% (p = 0.01), ventilatory work including respiratory frequency in rest > 40 cycles/min; 70% of them had asynchronous thoracic and abdominal muscles during sleep (p < 0.01 for all comparisons). Seventy percent of patients had bronchospasms (p = 0.02). The 49 infants had a favourable outcome, allowing weaning from MV or O2 between the ages of 2 and 4 years.
Conclusions:
These findings suggest that major respiratory failure in prematurely born infants can be overcome with prolonged respiratory and nutritional supports during the post-natal period of lung development; Cl dyn < 50% is a cursor for prolonged MV and weaning from MV should be excluded as long as increased ventilatory work persists.