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Zafar A, Hall M. Types of home respiratory support in children with bronchopulmonary dysplasia and factors determining its duration: A scoping review. Pediatr Pulmonol 2024; 59:834-844. [PMID: 38197530 DOI: 10.1002/ppul.26848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 01/11/2024]
Abstract
Bronchopulmonary dysplasia also known as chronic lung disease of prematurity has changed as a disease entity over the last five decades and children with "new bronchopulmonary dysplasia (BPD)" have better survival rates. This necessitates strategies to prevent severe BPD and provide organized home support. Home respiratory support in these children varies from home oxygen to noninvasive ventilation and tracheostomy ventilation. This review was conducted utilizing Joanna Briggs Institute publications on evidence synthesis and presentation of results for a scoping review. The Preferred Reporting Items for Systematic Review and Meta-Analyses were used to report the results. The risk of bias assessment was done using "The Cochrane Handbook for Systematic Reviews tool for interventional studies." After screening for the duplication of results and applying inclusion and exclusion criteria, twenty-seven studies were assessed by reading the full texts. Out of these, eleven were finally included in this systematic review. The total sample size from all studies was 4794, including 2705 males. The 4/11 studies home oxygen, one study reported continuous positive airway pressure/bilevel positive airway pressure and seven studies used tracheostomy or tracheostomy ventilation. The median duration of post-natal invasive ventilation was higher in those discharged on home oxygen compared to those who did not need oxygen at discharge. There is a significant proportion of children who are tracheostomy ventilated (8.65%) at home. In the absence of established guidelines, these children are vulnerable when it comes to care at home and the timing of decannulation. For home oxygen alone, guidelines by ERS, ATS and BTS have streamlined weaning protocols and the need for having a multi-disciplinary team to care for these children.
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Affiliation(s)
- Adnan Zafar
- Pediatric Pulmonology, John Hopkins Aramco Healthcare, Saudi Arabia
| | - Michael Hall
- Neonatology, University of Southampton, Southampton, UK
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Bhandari A, Alexiou S. Outpatient management of established bronchopulmonary dysplasia: An update. Semin Perinatol 2023; 47:151820. [PMID: 37777461 DOI: 10.1016/j.semperi.2023.151820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
As the incidence of infants with bronchopulmonary dyspasia (BPD) has continued to rise, so has their rate of survival. Their medical management is often complex and requires the use of numerous therapies such as steroids, bronchodilators, diuretics and modalities to deliver supplemental oxygen and positive pressure. It also requires multi-disciplinary care to ensure adequate growth and to optimize neurodevelopmental outcomes. This review aims to discuss the most widely used therapies in the treatment of patients with established BPD. The focus will be on ongoing outpatient (post-neonatal intensive care) management of children with BPD. Since many of the mentioned therapies lack solid evidence to support their use, more high quality research, such as randomized controlled trials, is needed to assess their effectiveness using defined outcomes.
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Affiliation(s)
- Anita Bhandari
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Blvd. Philadelphia, PA 19104, United States.
| | - Stamatia Alexiou
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Blvd. Philadelphia, PA 19104, United States
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McGlynn JR, Aoyama BC, Martin A, Collaco JM, McGrath-Morrow SA. Outpatient respiratory outcomes in children with BPD on supplemental oxygen. Pediatr Pulmonol 2023; 58:1535-1541. [PMID: 36798004 PMCID: PMC10121862 DOI: 10.1002/ppul.26356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Preterm children with bronchopulmonary dysplasia (BPD) frequently require supplemental oxygen in the outpatient setting. In this study, we sought to determine patient characteristics and demographics associated with need for supplemental oxygen at initial hospital discharge, timing to supplemental oxygen liberation, and associations between level of supplemental oxygen and likelihood of respiratory symptoms and acute care usage in the outpatient setting. METHODS A retrospective analysis of subjects with BPD on supplemental oxygen (O2 ) was performed. Subjects were recruited from outpatient clinics at Johns Hopkins University and the Children's Hospital of Philadelphia between 2008 and 2021. Data were obtained by chart review and caregiver questionnaires. RESULTS Children with BPD receiving ≥1 L of O2 were more likely to have severe BPD, pulmonary hypertension, and be older at initial hospital discharge. Children discharged on higher levels of supplemental O2 were slower to wean to room air compared to lower O2 groups (p < 0.001). Additionally, weaning off supplemental O2 in the outpatient setting was delayed in children with gastrostomy tubes and those prescribed inhaled corticosteroids, on public insurance or with lower household incomes. Level of supplemental O2 at discharge did not influence outpatient acute care usage or respiratory symptoms. CONCLUSION BPD severity and level of supplemental oxygen use at discharge did not correlate with subsequent acute care usage or respiratory symptoms in children with BPD. Weaning of O2 however was significantly associated with socioeconomic status and respiratory medication use, contributing to the variability in O2 weaning in the outpatient setting.
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Affiliation(s)
- Julianne R. McGlynn
- Children’s Hospital of Philadelphia Division of Pulmonary Medicine and Sleep and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brianna C. Aoyama
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Amanda Martin
- Children’s Hospital of Philadelphia Division of Pulmonary Medicine and Sleep and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph M. Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Sharon A. McGrath-Morrow
- Children’s Hospital of Philadelphia Division of Pulmonary Medicine and Sleep and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Long-term burden of respiratory complications associated with extreme prematurity: An analysis of US Medicaid claims. Pediatr Neonatol 2022; 63:503-511. [PMID: 35817695 DOI: 10.1016/j.pedneo.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Infants born extremely premature (EP) (<28 weeks gestational age) are at high risk of complications, particularly bronchopulmonary dysplasia (BPD), which can develop into chronic lung disease (CLD). METHODS The burden of respiratory complications in EP infants up to 2 years corrected age (CA) was evaluated using real-world data from the US Medicaid program. Data recorded between 1997 and 2018 on EP infants without major congenital malformations were collected from Medicaid records of six states. EP infants were divided into three cohorts: BPD, CLD, and without BPD or CLD. The incidence of respiratory conditions, respiratory medication use, and healthcare resource utilization were compared between the BPD cohort and CLD cohort versus the cohort without BPD or CLD, using unadjusted and adjusted generalized linear models. RESULTS A total of 4462 EP infants were identified (17.4% of all premature infants in the database). Of these, BPD and CLD were diagnosed in 61.9% and 72.1%, respectively, and 14.5% were diagnosed with neither BPD nor CLD. Compared with infants without BPD or CLD, infants with BPD or CLD had more complications and a longer length of birth hospitalization stay. Respiratory distress syndrome was the most frequently reported complication (94.6%, 92.5%, and 82.3% of EP infants in the BPD, CLD, and without BPD or CLD cohorts, respectively). After the birth hospitalization, respiratory conditions, respiratory medication use, and incidence rates of rehospitalizations, emergency room visits, and outpatient visits were higher for infants with BPD or CLD. Rehospitalization occurred in 50.5%, 51.6%, and 27.3% of EP infants with BPD, CLD, or without BPD or CLD, respectively; most hospitalizations occurred for respiratory-related reasons. CONCLUSION In this analysis of a large population of EP infants up to 2 years CA, respiratory conditions were prevalent after the birth hospitalization and were associated with high rates of medication and healthcare resource utilization.
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Andrews E, Sur A. Is inhaled budesonide a useful adjunct for the prevention or management of bronchopulmonary dysplasia? Arch Dis Child 2020; 105:508-511. [PMID: 32217527 DOI: 10.1136/archdischild-2019-318762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Emily Andrews
- Department of Neonatology, Lancashire Women and Newborn Centre, East Lancashire Hospitals NHS Trust, Burnley, Lancashire, UK
| | - Amitava Sur
- Department of Neonatology, Lancashire Women and Newborn Centre, East Lancashire Hospitals NHS Trust, Burnley, Lancashire, UK
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Bhandari V. Designing a better definition of bronchopulmonary dysplasia. Pediatr Pulmonol 2019; 54:678-679. [PMID: 30864236 DOI: 10.1002/ppul.24305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Vineet Bhandari
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Polysomnography in Preterm Infants with Bronchopulmonary Dysplasia for Monitoring Sleep-Disordered Breathing and Pulmonary Reserve. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00141-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity, and its rate is not improving, despite advances in perinatal intensive care. Children with BPD diagnosed in the neonatal period have higher risks for hospitalizations for respiratory problems over the first few years of life, and they have more asthma in later childhood. Neonates diagnosed with BPD have substantial airway obstruction on lung function testing in later childhood and early adulthood, and many are destined to develop adult chronic obstructive pulmonary disease. Survivors with neonatal BPD have more adverse motor function, worse cognitive development and poorer academic progress than those without BPD. Long-term outcomes for children born extremely preterm will improve if the rate of BPD can be substantially reduced.
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Affiliation(s)
- Jeanie L Y Cheong
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Lex W Doyle
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Jackson WM, O’Shea TM, Allred EN, Laughon MM, Gower WA, Leviton A. Risk factors for chronic lung disease and asthma differ among children born extremely preterm. Pediatr Pulmonol 2018; 53:1533-1540. [PMID: 30160065 PMCID: PMC6716602 DOI: 10.1002/ppul.24148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/11/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the hypothesis that chronic lung disease of prematurity (CLD) is a risk factor for asthma in children born extremely preterm, and the hypothesis that the risk factors for CLD are similar to those for asthma. METHODS A retrospective analysis was performed using data collected prospectively from 882 children born before the 28th week of gestation between 2002 and 2004 who returned for follow-up at ages 12 and 24 months and 10 years. We created time-oriented logistic regression models to compare risk factors for CLD, defined as need for supplemental oxygen at 36 weeks postmenstrual age, and parent-reported asthma at 10 years of age. RESULTS CLD diagnosed during neonatal admission was associated with bronchodilator use at 12 months and 24 months (P < 0.001), but not with an asthma diagnosis at 10 years (Odds Ratio 1.3; 95% confidence interval 0.98-1.8). While risk factors for CLD include lower gestational age (OR 2.7; 1.5-4.7) and fetal growth restriction (OR 2.3; 1.4-3.7), risk factors for asthma include mother's eligibility for public insurance (Medicaid) (OR 1.8; 1.1-2.8), and higher weight gain velocity during the first year (OR 1.5; 1.02-2.2) and between the 2nd and 10th year (OR 1.7; 1.2-2.4). CONCLUSIONS Among children born extremely preterm, the diagnosis of CLD and its antecedents were associated with transient preschool wheezing, but not with asthma. Post-NICU factors, such as growth velocity and socioeconomic disadvantage, appear to have stronger associations with asthma than exposures during NICU admission.
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Affiliation(s)
- Wesley M. Jackson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - T. Michael O’Shea
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth N. Allred
- Departments of Neurology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Matthew M. Laughon
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - W. Adam Gower
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Alan Leviton
- Departments of Neurology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts
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Brady JM, Pouppirt N, Bernbaum J, D'Agostino JA, Gerdes M, Hoffman C, Cook N, Hurt H, Kirpalani H, DeMauro SB. Why do children with severe bronchopulmonary dysplasia not attend neonatal follow-up care? Parental views of barriers. Acta Paediatr 2018; 107:996-1002. [PMID: 29420848 DOI: 10.1111/apa.14265] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 11/29/2022]
Abstract
AIM To assess in children with severe bronchopulmonary dysplasia at a corrected age of 18-36 months: (i) Neonatal follow-up clinic attendance rates; (ii) Parent-identified reasons for difficulty attending neonatal follow-up. METHODS Mixed methods study utilising semi-structured phone interviews with parents of infants eligible for follow-up with severe bronchopulmonary dysplasia (defined as gestational age <32 weeks and requiring ≥30% FiO2 and/or >2 L nasal cannula at 36 weeks post-menstrual age) at 18-36 months corrected age. Questions addressed barriers to neonatal follow-up attendance. Enrolment continued to saturation (no new themes emerging). RESULTS A total of 58 infants (69% male) were enrolled. Infants were 26 ± 2.1 weeks gestational age and birth weight 794 ± 262 g. At 28 ± 5.8 months corrected age, 26% had never attended neonatal follow-up clinic, 16% stopped attending before discharge, 5% were discharged, and 53% were still followed. Longer travel distance from home to follow-up clinic was associated with poorer attendance. Parent-generated items related to neonatal follow-up barriers were coded into four themes: Logistics, Time, Perceptions and Emotional Stress. CONCLUSION Despite high risk of developmental delay in infants with severe bronchopulmonary dysplasia, neonatal follow-up rates are suboptimal. Careful review of parent-identified barriers could be utilised to develop targeted strategies to improve neonatal follow-up attendance in this high-risk population.
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Affiliation(s)
- Jennifer M. Brady
- Division of Neonatology; Children's Hospital of Philadelphia; Philadelphia PA USA
- Division of Neonatology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Nicole Pouppirt
- Division of Neonatology; Children's Hospital of Philadelphia; Philadelphia PA USA
| | - Judy Bernbaum
- Department of Pediatrics; Children's Hospital of Philadelphia; Philadelphia PA USA
| | - Jo Ann D'Agostino
- Department of Pediatrics; Children's Hospital of Philadelphia; Philadelphia PA USA
| | - Marsha Gerdes
- Department of Child and Adolescent Psychiatry and Behavior Sciences; Children's Hospital of Philadelphia; Philadelphia PA USA
| | - Casey Hoffman
- Department of Child and Adolescent Psychiatry and Behavior Sciences; Children's Hospital of Philadelphia; Philadelphia PA USA
| | - Noah Cook
- Division of Neonatology; Children's Hospital of Philadelphia; Philadelphia PA USA
| | - Hallam Hurt
- Division of Neonatology; Children's Hospital of Philadelphia; Philadelphia PA USA
| | - Haresh Kirpalani
- Division of Neonatology; Children's Hospital of Philadelphia; Philadelphia PA USA
| | - Sara B. DeMauro
- Division of Neonatology; Children's Hospital of Philadelphia; Philadelphia PA USA
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11
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Venkataraman R, Kamaluddeen M, Hasan SU, Robertson HL, Lodha A. Intratracheal Administration of Budesonide-Surfactant in Prevention of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants: A Systematic Review and Meta-Analysis. Pediatr Pulmonol 2017; 52:968-975. [PMID: 28165675 DOI: 10.1002/ppul.23680] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/16/2017] [Accepted: 01/20/2017] [Indexed: 11/05/2022]
Abstract
Despite the near universal adaptation of gentle mechanical ventilation, surfactant use and non-invasive respiratory support, bronchopulmonary dysplasia (BPD) remains one of the most common respiratory morbidities in very low birth weight (VLBW) infants. Thus, the objective of this review was to evaluate the efficacy of intra-tracheal administration of budesonide-surfactant mixture in preventing bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants. MEDLINE, EMBASE, and PubMed were searched for randomized clinical trials in which intra-tracheal administration of budesonide-surfactant was used to prevent BPD in infants. The primary outcomes were BPD and composite outcome of death or BPD. Meta-analysis of the two clinical trials revealed that infants who received intra-tracheal instillation of budesonide-surfactant mixture demonstrated 43% reduction in the risk of BPD (RR: 0.57; 95%CI: 0.43-0.76, NNT = 5). Although mortality was not different between the groups (OR: 0.61; 95%CI: 0.34-1.04), a 40% reduction was observed in the composite outcome of death or BPD in the budesonide-surfactant group (RR: 0.60; 95%CI: 0.49-0.74, NNT = 3). Thus, this review concludes that intra-tracheal administration of budesonide-surfactant combination was associated with decreased incidence of BPD alone or composite outcome of death or BPD in VLBW infants though there is a need for larger trials before it can be recommended as a standard of care.
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Affiliation(s)
| | | | - Shabih U Hasan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Abhay Lodha
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Peter Lougheed Centre, Calgary, Alberta, Canada
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12
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Jackson W, Hornik CP, Messina J, Guglielmo K, Watwe A, Delancy G, Valdez A, MacArthur T, Peter-Wohl S, Smith PB, Tolia VN, Laughon MM. In-hospital outcomes of premature infants with severe bronchopulmonary dysplasia. J Perinatol 2017; 37:853-856. [PMID: 28383537 PMCID: PMC5562519 DOI: 10.1038/jp.2017.49] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To characterize in-hospital outcomes of premature infants diagnosed with severe bronchopulmonary dysplasia (BPD). STUDY DESIGN Retrospective cohort study including premature infants with severe BPD discharged from 348 Pediatrix Medical Group neonatal intensive care units from 1997 to 2015. RESULTS There were 10 752 infants with severe BPD, and 549/10 752 (5%) died before discharge. Infants who died were more likely to be male, small for gestational age, have received more medical interventions and more frequently diagnosed with surgical necrotizing enterocolitis, culture-proven sepsis and pulmonary hypertension following 36 weeks of postmenstrual age compared with survivors. Approximately 70% of infants with severe BPD were discharged by 44 weeks of postmenstrual age, and 86% were discharged by 48 weeks of postmenstrual age. CONCLUSIONS A majority of infants diagnosed with severe BPD were discharged home by 44 weeks of postmenstrual age. These results may inform discussions with families regarding the expected hospital course of infants diagnosed with severe BPD.
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Affiliation(s)
- Wesley Jackson
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Julia Messina
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Katherine Guglielmo
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Anisha Watwe
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Glaire Delancy
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Alexander Valdez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Timothy MacArthur
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Sigal Peter-Wohl
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - P. Brian Smith
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Veeral N. Tolia
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Matthew M. Laughon
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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13
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Murthy K, Porta NFM, Lagatta JM, Zaniletti I, Truog WE, Grover TR, Nelin LD, Savani RC, Savani RC. Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia. J Perinatol 2017; 37:723-727. [PMID: 28181997 DOI: 10.1038/jp.2016.277] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/21/2016] [Accepted: 12/07/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the presence and sources of inter-center variation (ICV) in the risk of death or tracheostomy placement (D/T) among infants with severe bronchopulmonary dysplasia (sBPD)Study design:We analyzed the Children's Hospitals Neonatal Database between 2010 and 2013 to identify referred infants born <32 weeks' gestation with sBPD. The association between center and the primary outcome of D/T was analyzed by multivariable modeling. Hypothesized diagnoses/practices were included to determine if these explained any observed ICV in D/T. RESULTS D/T occurred in 280 (20%) of 1383 eligible infants from 21 centers. ICV was significant for D/T (range 2-46% by center, P<0.001) and tracheostomy placement (n=187, range 2-37%, P<0.001), but not death (n=93, range 0-19%, P=0.08). This association persisted in multivariable analysis (adjusted center-specific odds ratios for D/T varied 5.5-fold, P=0.009). CONCLUSIONS ICV in D/T is apparent among infants with sBPD. These results highlight that the indications for tracheostomy (and subsequent chronic ventilation) remain uncertain.
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Affiliation(s)
- K Murthy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University and The Ann &Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - N F M Porta
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University and The Ann &Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - J M Lagatta
- Department of Pediatrics, Medical College of Wisconsin and The Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - I Zaniletti
- Department of Analytics, Children's Hospital Association, Inc, Overland Park, KS &Department of Statistics, University of Missouri, Columbia, MO, USA
| | - W E Truog
- Department of Pediatrics, University of Missouri Kansas City School of Medicine and The Center for Infant Pulmonary Disorders, Children's Mercy Hospitals &Clinics, Kansas City, MO, USA
| | - T R Grover
- Department of Pediatrics, University of Colorado School of Medicine and The Colorado Children's Hospital, Aurora, CO, USA
| | - L D Nelin
- Department of Pediatrics and Center for Perinatal Research, The Ohio State University College of Medicine and The Nationwide Children's Hospital, Columbus, OH, USA
| | - R C Savani
- Department of Pediatrics, University of Texas Southwestern Medical Center and the Children's Medical Center of Dallas, Dallas, TX, USA
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14
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Dalgleish SR, Kostecky LL, Blachly N. Eating in "SINC": Safe Individualized Nipple-Feeding Competence, a Quality Improvement Project to Explore Infant-Driven Oral Feeding for Very Premature Infants Requiring Noninvasive Respiratory Support. Neonatal Netw 2016; 35:217-227. [PMID: 27461200 DOI: 10.1891/0730-0832.35.4.217] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Oral feeding is a developmental task for all premature infants. often, independent nipple feeding is the last barrier to discharge home from the NICU. A relationship exists between consistent, infant-driven feeding management practices and improved feeding performance. Conversely, a random approach to feeding may contribute to poor short-term and long-term clinical outcomes. We report a quality improvement project that was undertaken across five NICUs in an urban setting. our aim was to safely initiate and advance nipple feeding for very preterm neonates (born at <32 weeks gestation) who had a respiratory morbidity requiring nasal continuous positive airway pressure therapy. A novel algorithm entitled "eating in SINC: Safe individualized nipple-Feeding Competence" was developed. Safe individualized nipple-feeding competence involves the baby, the parents, and the health care team by using infant-driven strategies, common language, and developmentally appropriate goals while supporting fragile neonates to be skilled feeders.
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Affiliation(s)
- Stacey R Dalgleish
- Foothills Medical Centre, NICU, 5th Floor, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
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