Invasive mechanical ventilation at 36 weeks post-menstrual age, adverse outcomes with a comparison of recent definitions of bronchopulmonary dysplasia.

OBJECTIVES: To determine whether the need for invasive mechanical ventilation (iMV) at 36 weeks PMA in patients with severe bronchopulmonary dysplasia (sBPD) identifies those patients at highest risk for tracheostomy or gastrostomy, and to compare sBPD with recent definitions of BPD. STUDY DESIGN: Observational study from Jan 2015 to Sept 2019 using data from the BPD Collaborative Registry. RESULTS: Five hundred and sixty-four patients with sBPD of whom 24% were on iMV at 36 weeks PMA. Those on iMV had significantly (p < 0.0001) increased risk for tracheostomy or gastrostomy. The overall mortality rate was 3% and the risk for mortality was substantially greater in those on iMV than in those on noninvasive support at 36 weeks PMA (RR 13.8, 95% CI 4.3-44.5, p < 0.0001). When applying the NICHD definition (2016) 44% had Grade III BPD. When applying the NRN definition, 6% had Grade 1 BPD, 70% had Grade 2 BPD, and 24% had Grade 3 BPD. CONCLUSIONS: Patients with sBPD who were on iMV at 36 weeks had a significantly greater risk of inhospital mortality and survivors had a significantly greater risk of undergoing tracheostomy and/or gastrostomy. The use of type 2 sBPD or Grade 3 BPD would enhance the ability to target future studies to those infants with sBPD at the highest risk of adverse long-term outcomes.

Predicting survival in infants born at <27 weeks gestation admitted to an all referral neonatal intensive care unit: a pilot study.

BACKGROUND: There are no available predictive models for survival in extremely preterm (EP) infants admitted to a referral Level IV neonatal intensive care unit (NICU) after the first day of life (DOL). OBJECTIVE: To determine if there are clinical variables present at admission that are associated with survival in an outborn EP population. STUDY DESIGN: Data were analyzed from EP infants admitted before DOL 100 from 2008 to 2016 (n = 744). RESULTS: We found that prophylactic indomethacin (OR 1.98 (1.20-3.25) p = 0.007), admit DOL (OR 1.05 (1.02-1.08) p < 0.001), and birth in Franklin County, (OR 2.02 (95% CI, 1.04-3.90) p = 0.04) were all associated with survival. Using ROC analysis, the area under the curve for the provisional survival score was 0.69 (95% CI, 0.64-0.75; p < 0.0001). CONCLUSIONS: There are factors on admission to a referral Level IV NICU associated with survival in EP patients.