Observational cohort study of changing trends in non-invasive ventilation in very preterm infants and associations with clinical outcomes

Sand, Laura; Szatkowski, Lisa; Kwok, T'ng Chang; Sharkey, Don; Todd, David A; Budge, Helen; Ojha, Shalini

doi:10.1136/archdischild-2021-322390

Cited by 37 publications

(33 citation statements)

References 24 publications

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“…In the subgroup analysis including only the extremely preterm infants, we found that the percentage who died was significantly higher in the group that did not have a PDA and the adjusted odds of death remained statistically significantly higher in that group even after adjustment for GA. We did not exclude early deaths and infants who survived were more likely to have undergone a clinical or echocardiographic evaluation resulting in a diagnosis of PDA as compared with those who did not live long enough for such a diagnosis to be made. We have reported similar confounding in other reports10 and such survival bias is a recognised limitation of observational studies particularly in a population such as extremely preterm infants where there is a high risk of early deaths.…”

Section: Discussionsupporting

confidence: 82%

Management of patent ductus arteriosus in very preterm infants in England and Wales: a retrospective cohort study

Al-Turkait

Szatkowski

Choonara

et al. 2022

bmjpo

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ObjectiveTo describe the diagnosis and treatment of patent ductus arteriosus (PDA) in infants born at <32 weeks’ gestational age (GA) in England and Wales between 2010 and 2017.Study designRetrospective cohort study using routinely recorded data from the National Neonatal Research Database of infants born at <32 weeks admitted to neonatal units in England and Wales from 2010 to 2017.ResultsAmong 58 108 infants born at <32 weeks’ GA, 28.3% (n=16 440) had a PDA diagnosed clinically or with echocardiographic confirmation. Of these, 34.8% (n=5721; 9.8% of total <32 weeks’ infants included) had PDA treatment including 7.6% (n=1255) with indomethacin, 23.5% (n=3857) with ibuprofen and 5.6% (n=916) with surgical closure. The highest incidence of PDA was among infants born at 24 and 25 weeks’ GA (70.2% and 70.8%, respectively), decreasing to 6.1% among infants born at 31 weeks’ GA. The percentage of infants with a PDA increased over the study period (25.5% in 2010 to 28.5% in 2017). The percentage of infants who received ibuprofen or indomethacin or had PDA surgery decreased from 41.3% in 2010 to 33.7% in 2017, with an increase in use of ibuprofen from 20.2% to 27.3% while use of indomethacin decreased from 20.0% to 8.8%. Surgical closure of PDA decreased from 9.1% to 3.0%. Indomethacin was used for median (IQR) 3 (2–5) days while ibuprofen was given for 3 (2-4) days, at a median of 8 and 10 days after birth, respectively; surgical treatment was used later at 33 (24–45) days after birth.ConclusionsIbuprofen is the preferred drug and surgical interventions are becoming less frequent for PDA closure among very preterm infants in England and Wales.Trial registration numberNCT03773289.

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Section: Discussionsupporting

confidence: 82%

Management of patent ductus arteriosus in very preterm infants in England and Wales: a retrospective cohort study

Al-Turkait

Szatkowski

Choonara

et al. 2022

bmjpo

Self Cite

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“…In this group of patients, HFNT is an increasingly used alternative to low-flow oxygen and noninvasive or invasive ventilatory support for the long-term management of respiratory insufficiency. 11 HFNT reduces the work of breathing to an extent comparable to CPAP. 12 Simple handling, good patient tolerance of a comfortable interface with an overall good accessibility of the child render HFNT particularly attractive for neonates and infants.…”

Section: Discussionmentioning

confidence: 96%

Indications and outcome of home high‐flow nasal therapy in children, a single‐center experience

Steindor

Wagner

Kavvalou

et al. 2022

Pediatric Pulmonology

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High‐flow nasal therapy (HFNT) is a safe and simple way to deliver humidified air and oxygen for respiratory support in infants and children. HFNT is well established in an inpatient setting, but home HFNT lacks evidence. In the current study, we studied characteristics and outcomes of pediatric patients with home HFNT. In a monocentric retrospective analysis of data for 10 years (April 2010–April 2020), patient characteristics from the time point of the first discharge from hospital with home HFNT‐treatment and the subsequent course were analyzed. Patients were divided into three HFNT indication groups: (1) bronchopulmonary dysplasia (BPD), (2) upper airway obstruction (UAO), and (3) other indications. Forty patients received home HFNT in the study period. Seventeen patients were treated for BPD, 15 for UAO, and 8 had other indications. Twenty‐two patients (55%) were successfully weaned from HFNT (12 [70.6%] BPD, 7 [46.7%] UAO, 3 [37.5%] other), while seven patients (17.5%) died during follow‐up (4 BPD, 2 UAO, 1 other). Twenty‐three patients (57.5%) required (intermittent) additional oxygen application (14 [82.4%] BPD, 6 [40%] UAO, 4 [50%] other). Weaning success and need for additional oxygen were significantly more probable in BPD patients compared to the UOA group. In conclusion, HFNT plays an increasing role in home treatment of respiratory insufficiency of various etiologies in childhood. It often represents a temporary intervention, especially for children with BPD but might also serve as long‐term treatment for children in whom other forms of ventilatory support are not feasible or desired.

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“…30 Our classification could be clinically useful in further understanding the pathophysiology of extremely preterm morbidity and mortality and possibly in targeting selected subgroups of infants for specific interventions. For example, for cluster 4, such interventions might include administration of postnatal corticosteroids to assist earlier weaning from invasive respiratory support, 31 more gentle resuscitation methods, avoidance of mechanical ventilation by newer non-invasive techniques 32 and use of less invasive surfactant administration, which has been shown to reduce the incidence of BPD. 33 The within-group association of increased mortality and birth outside a tertiary hospital in cluster 3 could also strengthen the argument for the centralisation of the care of extreme preterms concentrating on high-volume perinatal centres.…”

Section: Discussionmentioning

confidence: 99%

Using cluster analysis to describe phenotypical heterogeneity in extremely preterm infants: a retrospective whole-population study

et al. 2022

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ObjectiveTo use cluster analysis to identify discrete phenotypic groups of extremely preterm infants.DesignSecondary analysis of a retrospective whole population study.SettingAll neonatal units in England between 2014 and 2019.ParticipantsInfants live-born at less than 28 weeks of gestation and admitted to a neonatal unit.InterventionsK-means cluster analysis was performed with the gestational age, Apgar score at 5 min and duration of mechanical ventilation as input variables.Primary and secondary outcome measuresBronchopulmonary dysplasia, discharge on home oxygen, intraventricular haemorrhage, death before discharge from neonatal care.ResultsTen thousand one hundred and ninety-seven infants (53% male) were classified into four clusters: Cluster 1 contained infants with intermediate gestation and duration of ventilation and had an intermediate mortality and incidence of bronchopulmonary dysplasia. Cluster 2 contained infants with the highest gestation, a shorter duration of ventilation and the lowest mortality. Cluster 3 contained infants with the lowest Apgar score and highest mortality and incidence of intraventricular haemorrhage. Cluster 4 contained infants with the lowest gestation, longest duration of ventilation and highest incidence of bronchopulmonary dysplasia.ConclusionClinical parameters can classify extremely preterm infants into discrete phenotypic groups with differing subsequent neonatal outcomes.

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Observational cohort study of changing trends in non-invasive ventilation in very preterm infants and associations with clinical outcomes

Cited by 37 publications

References 24 publications

Management of patent ductus arteriosus in very preterm infants in England and Wales: a retrospective cohort study

Management of patent ductus arteriosus in very preterm infants in England and Wales: a retrospective cohort study

Indications and outcome of home high‐flow nasal therapy in children, a single‐center experience

Using cluster analysis to describe phenotypical heterogeneity in extremely preterm infants: a retrospective whole-population study

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