258 - Outcomes of Infants with Bronchopulmonary Dysplasia and Tracheobronchomalacia who required Tracheostomy for Home Ventilation

Publication Number: 258.5816

Gangaram Akangire, Children's Mercy, Kansas City, MO, United States; Addie G. Begley, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Karishma Rao, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Jason R. Brown, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Janelle Noel-MacDonnell, Children's Mercy, Kansas City, MO, United States; Daniel Jensen, Children's Mercy Hospital, Kansas City, MO, United States; Charisse I.. Lachica, Children's Mercy Kansas City, Kansas City, MO, United States; Winston Manimtim, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States

Background: Forty percent of pediatric tracheostomy is performed in children under 1 year of age. The significant increase in the rate of tracheostomy in infants is partly attributed to the increased survival of extremely premature infants who develop severe bronchopulmonary dysplasia (BPD) and require long-term invasive ventilation. Recent literature classifies BPD into clinical phenotypes namely, parenchymal, vascular and airway. Outcomes data based on these BPD phenotypes is lacking.

Objective: To describe the survival rate, timing of liberation from home ventilator, decannulation and growth of infants with severe BPD and tracheobronchomalacia (TBM) who had tracheostomy for long-term home ventilation.

Design/Methods: A retrospective cohort study was conducted on 38 infants born between 2004-2017 with severe BPD and TBM and tracheostomy performed at < 1 year of age and cared for in the Infant Tracheostomy and Home Ventilator Clinic through 4 years of age. Diagnosis of TBM was based on bronchoscopy and/or chest computed tomography.

Results: Thirty-eight (38) subjects were included in the cohort, 36 had tracheostomy and ventilator dependence at the time of discharge while 2 had tracheostomy only. (Table 1) Median gestational age at birth was 26 weeks (IQR 24, 28). Median birth weight was 772 grams (IQR 530, 900). Median age at tracheostomy was 4 months (IQR 3, 5) chronologic age, (or 43 weeks postmenstrual age). Median age at NICU discharge was 7 months (IQR 6, 9). All subjects were liberated from home ventilator by 4 years of age. Median age at liberation from home ventilator was 25 months (IQR 19, 31). Sixteen (42%) infants were decannulated by 4 years of age. Of those decannulated, the median age at decannulation was 33 months (IQR 25, 38). (Figure 1) All subjects survived throughout the study period. Eight (21%) infants had polysomnogram prior to decannulation. Fourteen (37%) infants had evidence of pulmonary hypertension at the time of discharge. All infants received gastrostomy tube for feeding and nutritional support. The z-scores for weight and weight/length showed steady growth throughout the study period. (Figure 2)

Conclusion(s): All infants with severe BPD and TBM who required tracheostomy for chronic invasive ventilation survived and were liberated from home ventilator by 4 years of age. Less than half of them were decannulated by 4 years of age. Multidisciplinary care of these medically complex infants may lead to improved survival, respiratory and growth outcomes.

Figure 1
Liberation from home ventilator and decannulation over 4 years of age

Figure 2
Weight and weight/length for the study subjects over 3 years of age

Table 1
Demographic and outcome data for the study cohort