In-hospital outcomes of premature infants with severe bronchopulmonary dysplasia

W Jackson, C P Hornik, J A Messina, K Guglielmo, A Watwe, G Delancy, A Valdez, T MacArthur, S Peter-Wohl, P B Smith, V N Tolia, M M Laughon, W Jackson, C P Hornik, J A Messina, K Guglielmo, A Watwe, G Delancy, A Valdez, T MacArthur, S Peter-Wohl, P B Smith, V N Tolia, M M Laughon

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.

Conflict of interest statement

Conflicts of Interest

CPH receives salary support for research from the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001117).

PBS receives salary support for research from the National Institutes of Health (NIH-1R21HD080606-01A1) and the National Institute for Child Health and Human Development (HHSN275201000003I).

SP receives salary support for research from the Gerber Foundation and the National Institute of Allergy and Infectious Diseases (R01 AI1000067-01; PI De Paris).

MML is supported by the U.S. government for his work in pediatric and neonatal clinical pharmacology by Eunice Kennedy Shriver National Institute of Child Health and Human Development (Contract HHSN267200700051C; PI Benjamin), the Food and Drug Administration Office of Orphan Product Development (R01 FD005101; PI Laughon) and the National Heart, Lung, and Blood Institute (R34 HL124038; PI Laughon).

Figures

Figure 1. Respiratory support over time in…
Figure 1. Respiratory support over time in hospitalized premature infants with severe BPD
Abbreviations: HFNC = high-flow nasal cannula; CPAP = continuous positive airway pressure; NIPPV = nasal-intermittent positive pressure ventilation; CV = conventional mechanical ventilation; HFV = high-frequency ventilation

References

    1. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993–2012. JAMA. 2015 Sep 8;314(10):1039–1051.
    1. Parker RA, Lindstrom DP, Cotton RB. Improved survival accounts for most, but not all, of the increase in bronchopulmonary dysplasia. Pediatrics. 1992 Nov;90(5):663–668.
    1. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001 Jun;163(7):1723–1729.
    1. Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, Fanaroff AA, et al. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics. 2005 Dec;116(6):1353–1360.
    1. Laughon M, O’Shea MT, Allred EN, Bose C, Kuban K, Van Marter LJ, et al. Chronic lung disease and developmental delay at 2 years of age in children born before 28 weeks’ gestation. Pediatrics. 2009 Aug;124(2):637–648.
    1. Van Marter LJ, Kuban KC, Allred E, Bose C, Dammann O, O’Shea M, et al. Does bronchopulmonary dysplasia contribute to the occurrence of cerebral palsy among infants born before 28 weeks of gestation? Arch Dis Child Fetal Neonatal Ed. 2011 Jan;96(1):F20–9.
    1. Natarajan G, Pappas A, Shankaran S, Kendrick DE, Das A, Higgins RD, et al. Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia: impact of the physiologic definition. Early Hum Dev. 2012 Jul;88(7):509–515.
    1. Spitzer AR, Ellsbury D, Clark RH. The Pediatrix BabySteps(R) Data Warehouse - A Unique National Resource for Improving Outcomes for Neonates. Indian J Pediatr. 2015 Jul;82(71):669.
    1. Benaron DA, Benitz WE. Maximizing the stability of oxygen delivered via nasal cannula. Arch Pediatr Adolesc Med. 1994 Mar;148(3):294–300.
    1. Vain NE, Prudent LM, Stevens DP, Weeter MM, Maisels MJ. Regulation of oxygen concentration delivered to infants via nasal cannulas. Am J Dis Child. 1989 Dec;143(12):1458–1460.
    1. Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics. 2010 Feb;125(2):e214–24.
    1. Watterberg KL, American Academy of Pediatrics Committee on Fetus and Newborn. Policy statement–postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia. Pediatrics. 2010 Oct;126(4):800–808.
    1. Lodha A, Seshia M, McMillan DD, Barrington K, Yang J, Lee SK, et al. Association of early caffeine administration and neonatal outcomes in very preterm neonates. JAMA Pediatr. 2015 Jan;169(1):33–38.
    1. Schmidt B, Roberts RS, Davis P, Doyle LW, Barrington KJ, Ohlsson A, et al. Caffeine therapy for apnea of prematurity. N Engl J Med. 2006 May 18;354(20):2112–2121.
    1. Taha D, Kirkby S, Nawab U, Dysart KC, Genen L, Greenspan JS, et al. Early caffeine therapy for prevention of bronchopulmonary dysplasia in preterm infants. J Matern Fetal Neonatal Med. 2014 Nov;27(16):1698–1702.
    1. Wade KC, Lorch SA, Bakewell-Sachs S, Medoff-Cooper B, Silber JH, Escobar GJ. Pediatric care for preterm infants after NICU discharge: high number of office visits and prescription medications. J Perinatol. 2008 Oct;28(10):696–701.
    1. Lodha A, Ediger K, Rabi Y, Lodha S, Tang S, Bhandari A, et al. Does chronic oxygen dependency in preterm infants with bronchopulmonary dysplasia at NICU discharge predict respiratory outcomes at 3 years of age? J Perinatol. 2015 Jul;35(7):530–536.
    1. McGrath-Morrow SA, Hayashi M, Aherrera AD, Collaco JM. Respiratory outcomes of children with BPD and gastrostomy tubes during the first 2 years of life. Pediatr Pulmonol. 2014 Jun;49(6):537–543.
    1. McQueen M, Rojas J, Sun SC, Tero R, Ives K, Bednarek F, et al. Safety and Long Term Outcomes with High Flow Nasal Cannula Therapy in Neonatology: A Large Retrospective Cohort Study. J Pulm Respir Med. 2014 Dec;4(6):216.
    1. Manley BJ, Owen LS. High-flow nasal cannula: Mechanisms, evidence and recommendations. Semin Fetal Neonatal Med. 2016 Jun;21(3):139–145.
    1. Nath P, Ponnusamy V, Willis K, Bissett L, Clarke P. Current practices of high and low flow oxygen therapy and humidification in UK neonatal units. Pediatr Int. 2010 Dec;52(6):893–894.
    1. Manley BJ, Owen L, Doyle LW, Davis PG. High-flow nasal cannulae and nasal continuous positive airway pressure use in non-tertiary special care nurseries in Australia and New Zealand. J Paediatr Child Health. 2012 Jan;48(1):16–21.
    1. Walsh M, Engle W, Laptook A, Kazzi SN, Buchter S, Rasmussen M, et al. Oxygen delivery through nasal cannulae to preterm infants: can practice be improved? Pediatrics. 2005 Oct;116(4):857–861.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit