Outcomes of infants with severe bronchopulmonary dysplasia who received tracheostomy and home ventilation

Abstract

Objective To describe the survival rate, timing of liberation from the ventilator, and factors favorable for decannulation among infants with severe bronchopulmonary dysplasia (sBPD) who received tracheostomy. Methods Demographics and clinical outcomes were obtained through retrospective chart review of 98 infants with sBPD who were born between 2004 and 2017, received tracheostomy at <1 year of age, and were followed in the Infant Tracheostomy and Home Ventilator clinic up to 4 years of age. Results The number of infants with sBPD who received tracheostomy increased significantly over the study period. The median age at tracheostomy was 4 months (IQR 3, 5) or 43 weeks corrected gestational age; the median age at NICU discharge was 7 months (IQR 6, 9). At 48 months of age, all subjects had been liberated from the ventilator, at a median age of 24 months (IQR 18, 29); 52% had been decannulated with a median age at decannulation of 32 months (IQR 26, 39). Only 1 (1%) infant died. Multivariate logistic regression showed infants who were White, liberated from the ventilator by 24 months of age and have public insurance had significantly greater odds of being decannulated by 48 months of age. Tracheobronchomalacia was associated with decreased odds of decannulation. Conclusion Infants with sBPD who received tracheostomy had an excellent survival rate. Liberation from home ventilation and decannulation are likely to occur by 4 years of age.

Predictors for invasive home mechanical ventilation duration in bronchopulmonary dysplasia

“…In this retrospective cohort study, we found considerable variation in the time children spent on IHMV. Only half of the population weaned off IHMV after 2 years and about 90% weaned off IHMV after 4 years, which is consistent with other institutions' findings 1,22,35 . We also found that children who were Hispanic/Latinx ethnicity were more likely to use IHMV longer compared to non‐Hispanic White patients as did those with higher DACT in both univariable and multivariable models.…”

“…While we recognize that race and ethnicity is a social construct, structural barriers including bias and racism are known to play a role in access to health outcomes 26 . This finding is consistent with a recent paper examining time to decannulation in infants with BPD; its multivariable, logistic regression showed that infants who were White race had significantly greater odds of being decannulated by 48 months of age compared to non‐White patients 22 . While ethnicity is a different social variable than socioeconomic status, these findings are also consistent with a recent paper that found children from lower socioeconomic groups use tracheostomy for 10 months longer than children from higher socioeconomic groups 36 .…”

“…Previous seminal studies have described tracheostomy duration, total IHMV duration, and factors associated with IHMV liberation and mortality on IHMV. 1,2,4,[18][19][20][21][22] However, the literature has not yet identified factors associated with duration of time children spend on positive pressure IHMV once home. A recent review stated that early predictors of long-term outcomes remain unclear.…”

“…Understanding which factors contribute to the duration of time children with BPD spend on IHMV remains an understudied area. Previous seminal studies have described tracheostomy duration, total IHMV duration, and factors associated with IHMV liberation and mortality on IHMV 1,2,4,18–22 . However, the literature has not yet identified factors associated with duration of time children spend on positive pressure IHMV once home.…”

Tracheostomy in infants with severe bronchopulmonary dysplasia: A review

“…More recent studies, including one from our center, have shown a similar median age of liberation from the ventilator and age of decannulation ( 7 , 19 , 39 – 41 ). Specific to our cohort, we found that ventilator-dependent infants with severe BPD have much greater odds of successful weaning from the ventilator and decannulation by three to four years of age, compared to those infants with other indications for tracheostomy and chronic invasive ventilation at home ( 19 , 42 ). Table 1 summarizes the respiratory outcomes to date of infants with severe BPD who were chronically ventilated at home through a tracheostomy.…”