Abstract
ObjectivesTo determine whether the need for invasive mechanical ventilation (iMV) at 36 weeks PMA in patients with severe bronchopulmonary dysplasia (sBPD) identifies those patients at highest risk for tracheostomy or gastrostomy, and to compare sBPD with recent definitions of BPD.Study designObservational study from Jan 2015 to Sept 2019 using data from the BPD Collaborative Registry.ResultsFive hundred and sixty-four patients with sBPD of whom 24% were on iMV at 36 weeks PMA. Those on iMV had significantly (p < 0.0001) increased risk for tracheostomy or gastrostomy. The overall mortality rate was 3% and the risk for mortality was substantially greater in those on iMV than in those on noninvasive support at 36 weeks PMA (RR 13.8, 95% CI 4.3–44.5, p < 0.0001). When applying the NICHD definition (2016) 44% had Grade III BPD. When applying the NRN definition, 6% had Grade 1 BPD, 70% had Grade 2 BPD, and 24% had Grade 3 BPD.ConclusionsPatients with sBPD who were on iMV at 36 weeks had a significantly greater risk of inhospital mortality and survivors had a significantly greater risk of undergoing tracheostomy and/or gastrostomy. The use of type 2 sBPD or Grade 3 BPD would enhance the ability to target future studies to those infants with sBPD at the highest risk of adverse long-term outcomes.
Highlights
Despite marked improvements in the survival of extremely low birth weight preterm infants, bronchopulmonary dysplasia (BPD) remains the most common cause of morbidity and mortality in this population
The risk for mortality after 36 weeks post-menstrual age (PMA) was substantially greater in patients receiving invasive mechanical ventilation (iMV) at 36 weeks PMA than in those severe BPD (sBPD) patients on noninvasive respiratory support at 36 weeks PMA (RR 13.8, 95% CI 4.3–44.5, p < 0.0001)
The risk for tracheostomy (RR 6.6, 95% CI 3.7–11.5, p < 0.0001) or gastrostomy (RR 2.1, 95% CI 1.6–2.8, p < 0.0001) were significantly greater for patients receiving iMV at 36 weeks PMA than compared to those who were receiving noninvasive respiratory support at 36 weeks PMA (Table 2)
Summary
There were 584 patients identified in the Registry with complete data at 36 weeks PMA, of which 20 had moderate BPD by the 2000 NIH consensus definition and were excluded. The risk for tracheostomy (RR 6.6, 95% CI 3.7–11.5, p < 0.0001) or gastrostomy (RR 2.1, 95% CI 1.6–2.8, p < 0.0001) were significantly greater for patients receiving iMV at 36 weeks PMA than compared to those who were receiving noninvasive respiratory support at 36 weeks PMA (Table 2). Fewer sBPD patients who were on iMV at 36 weeks PMA were discharged on low-flow nasal cannula oxygen compared to sBPD patients on noninvasive respiratory support (Fig. 2). More sBPD patients who were on iMV at 36 weeks PMA were discharged on tracheal collar or positive pressure compared to sBPD patients on noninvasive support at 36 weeks PMA (Fig. 2). The sBPD patients on iMV at 36 weeks PMA were treated more often with β-agonists and corticosteroids at discharge compared to those on noninvasive respiratory support (Table 1). The NRN definition placed 6% of patients classified as sBPD into Grade 1 BPD and these patients had no mortality and the shortest LOS
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