WIP 70 - Time-resolved changes in Dynamic Lung Compliance to assess response to systemic steroids in intubated infants <32 weeks gestation.

Publication Number: WIP 70.7516

Jermine Harriet Romald, Childrens mercy, Overland Park, KS, United States; Venkatesh Sampath, University of Missouri-Kansas City School of Medicine, kansas city, MO, United States; Keith Feldman, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Brooke Smith, Children's Mercy Hospitals and Clinics, Kansas city, MO, United States; Alain Cuna, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States

Background: Prolonged assisted ventilation is a major cause of Bronchopulmonary Dysplasia in premature infants that is linked to reduced lung function. Corticosteroids have proven beneficial effect in the prevention of BPD by improving lung compliance and thereby facilitating extubation. However, there exists significant heterogeneity in response to systemic corticosteroids. Current guidelines used to wean infants from ventilators rely on highly variable operator-dependent assessments. There is a clear need to develop an objective functional tool to assess changes in pulmonary compliance and to identify non responders to postnatal corticosteroid treatment as prolonged use is associated with cerebral palsy and poor neurodevelopmental outcome. We hypothesize that temporal trends in dynamic compliance predicts responsiveness to systemic steroids and extubation success in preterm infants.

Objective: 1)Derive novel profiles of continuous time-resolved dynamic compliance in intubated preterm infants and determine correlation with other measures of pulmonary function.
2)To determine whether changes in dynamic compliance can predict responsiveness to systemic dexamethasone use and extubation success.

Design/Methods: This is a prospective cohort study of 25 intubated infants < 32 weeks gestation receiving systemic steroids (Dexamethasone or Prednisolone) to facilitate extubation [18 already recruited]. Granular minute-level compliance data will be extracted from mechanical ventilator of each infant and matched with other indices of lung function including set ventilatory parameters, tidal volumes and minute ventilation. Extensive clinical data including demographic data, days to extubate, comorbid conditions like tracheitis, patent ductus arteriosus, iNO, diuretic use and inhaled steroid used are being collected. Time series analysis will be used to extract lung compliance trajectories pre and post steroid administration and how these trends correlate with weaning from ventilator and extubation success (>72 hours off invasive mechanical ventilation). We aim to have results by January 2025.