Liberation from Respiratory Support in Bronchopulmonary Dysplasia - 09/06/25
, Isabella Zaniletti, PhD, MA 2, Joanne M. Lagatta, MD, MS 3, Michael A. Padula, MD, MBI 4, 2, Theresa R. Grover, MD 5, 2, Nicolas F.M. Porta, MD 6, Erica M. Wymore, MD 5, Erik A. Jensen, MD, MSCE 4, Kristen T. Leeman, MD 7, Jonathan C. Levin, MD, MBI 7, Jacquelyn R. Evans, MD 4, Sushmita Yallapragada, MD, MSCI 8, Leif D. Nelin, MD 1, Shilpha Vyas-Read, MD, MSc 9, Karna Murthy, MD, MSc 6, 2on behalf of the
Children's Hospitals Neonatal Consortium Severe BPD Focus Group
Abstract |
Objective |
To estimate the association between the mode of respiratory support administered at 36 weeks’ post-menstrual age (PMA) with time-to-liberation from respiratory support (LRS) in infants with grade 2/3 bronchopulmonary dysplasia (BPD).
Study design |
Daily respiratory support data were abstracted for infants born <32 weeks' gestation with grade 2/3 BPD enrolled in the Children's Hospital’s Neonatal Database between 2017 and 2022. The main exposure was the mode of respiratory support received at 36 weeks' PMA: high-flow nasal cannula >2 L/min (HFNC), continuous positive airway pressure (CPAP), non-invasive positive pressure ventilation (NIPPV), or mechanical ventilation (MV). The primary outcome was time-to-LRS, defined as the PMA when infants weaned to nasal cannula <2 L/min or room air for >2 days. The independent association between the main exposure and time-to-LRS was estimated using restricted mean survival time analysis.
Results |
Among 3483 included infants from 41 centers, 17% received HFNC, 36% CPAP, 16% NIPPV, and 32% MV at 36 weeks' PMA. After censoring those who died (4.2%), survived with tracheostomy (7.6%), or were transferred to another facility (7.5%), the median (IQR) time-to-LRS differed between groups: HFNC 37 [37, 39]; CPAP 39 [37, 41] NIPPV 41[39, 45]; and MV 44 [40, 48] weeks’ PMA (P < .001). Across centers, a 10-fold difference in time-to-LRS was observed after adjustment for clinical risk factors.
Conclusions |
For infants with grade 2/3 BPD, the mode of respiratory support prescribed at 36 weeks’ PMA and center of care were each associated with time-to-LRS independent of patient and clinical characteristics.
Le texte complet de cet article est disponible en PDF.Keywords : neonate, tracheostomy, neonatal intensive care, pediatric critical care, mechanical ventilation
Abbreviations : ASD, AVSD, BPD, BPD-PH, CHNC, CHND, CPAP, HFNC, LRS, MV, NICU, NIPPV, PDA, PMA, RMST, RSV, SGA, VSD
Plan
| This work was previously presented at the 2024 Pediatric Academic Societies Meeting in Toronto, Ontario, Canada. |
Vol 282
Article 114390- juillet 2025 Retour au numéro
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