Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

A multidisciplinary chronic lung disease team in a neonatal intensive care unit is associated with increased survival to discharge of infants with tracheostomy

Journal of Perinatology volume 41, pages 1963–1971 (2021)Cite this article

Subjects

Abstract

Objective

To determine if multidisciplinary team-based care of severe BPD/CLD infants improve survival to discharge.

Design/methods

Retrospective review of severe BPD/CLD infants cared for by dedicated multidisciplinary CLD team using consensus-driven protocols and guidelines.

Results

Total of 267 patients. Median gestational age was 26 weeks (IQR 24, 32); median birth-weight was 0.85 (IQR 0.64, 1.5). Twenty-four percent were preterm with severe BPD, 46% had other primary respiratory diseases (none BPD diseases). Total number of patients, proportion of patients with tracheostomy, prematurity, and genetic diagnoses increased over time. 88.8% survived to discharge. Unadjusted logistic regression showed that tracheostomy was not associated with odds of death; secondary pulmonary hypertension was associated with odds of tracheostomy (OR = 1.795 p value = 0.0264), or death (OR = 8.587 p value = <0.0001), or tracheostomy + death (OR = 13.58 p value = 0.0007).

Conclusions

Over time, mortality improved for infants with tracheostomy cared for by a multidisciplinary severe BPD/CLD team. Secondary pulmonary hypertension was associated with tracheostomy, or death, or tracheostomy + death.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Diagnosis trend over time.
Fig. 2: Simple linear regression (dotted lines) shows a positive average trend for number of patients with tracheostomy over time.

Similar content being viewed by others

References

  1. Northway WH Jr., Rosan RC, Porter DY. Pulmonary disease following respiratory therapy of hyaline-membrane disease, Bronchopulmonary dysplasia. N Engl J Med. 1967;276:357–68.

    Article  Google Scholar 

  2. Doyle LW, Anderson PJ. Long-term outcomes of bronchopulmonary dysplasia. Semin Fetal Neonatal Med. 2009;14:391–5.

    Article  Google Scholar 

  3. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723–9.

    Article  CAS  Google Scholar 

  4. 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;116:1353–60.

    Article  Google Scholar 

  5. Allen J, Zwerdling R, Ehrenkranz R, Gaultier C, Geggel R, Greenough A, et al. Statement on the care of the child with chronic lung disease of infancy and childhood. Am J Respir Crit Care Med. 2003;168:356–96.

    Article  Google Scholar 

  6. Bapat R, Nelin L, Shepherd E, Ryshen G, Elgin A, Bartman T. A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence. J Perinatol. 2020;40:681–7.

    Article  Google Scholar 

  7. Abman SH, Collaco JM, Shepherd EG, Keszler M, Cuecvas-Guaman M, Welty SE, et al. Interdisciplinary care of children with severe bronchopulmonary dysplasia. J Pediatr. 2018;197:300–8.

    Google Scholar 

  8. Gibbs K, Jensen E, Alexiou S, Munson D, Zhang H. Ventilation strategies in severe bronchopulmonary dysplasia. NeoReviews. 2020;21:e226–37.

    Article  Google Scholar 

  9. Rosterman JL, Pallotto EK, Truog WE, Escobar H, Meinert KA, Holmes A, et al. The impact of neutrally adjusted ventilatory assist mode on respiratory severity score and energy expenditure in infants: a randomized crossover trial. J Perinatol. 2018;38:59–63.

    Article  CAS  Google Scholar 

  10. McKinney RL, Keszler M, Truog WE, Norberg M, Sindelar R, Wallstrom L, et al. Multicenter experience with neutrally adjusted ventilator assist in infants with severe bronchopulmonary dysplasia. Am J Perinatol. 2020. https://doi.org/10.1055/s-0040-1708559.

  11. Bamat NA, Kirpalani H, Feudtner C, Jensen EA, Laughon MM, Zhang H, et al. Medication use in infants with severe bronchopulmonary dysplasia admitted to United States children’s hospitals. J Perinatol. 2019;39:1291–9.

    Article  Google Scholar 

  12. Greenberg JM, Poindexter BB, Shaw PA, Bellamy SL, Keller RL, Moore PE, et al. Respiratory medication use in extremely premature (<29 weeks) infants during initial NICU hospitalization: results from prematurity and respiratory outcomes program. Pediatr Pulmonol. 2020;55:360–8.

    Article  Google Scholar 

  13. Overman AE, Liu M, Kurachek SC, Shreve MR, Maynard RC, Mammel MC, Moore BM. Tracheostomy for infants requiring prolonged mechanical ventilation: 10 years’ experience. Pediatrics. 2013;131:e1491–6.

    Article  Google Scholar 

  14. Lewis CW, Carron JD, Perkins JA, Sie KCY, Feudner C. Tracheostomy in pediatric patients: a national perspective. Arch Otolaryngol Head Neck Surg. 2003;129:523–9.

    Article  Google Scholar 

  15. Han SM, Watters KF, Hong CR, Edwards EM, Knell J, Morrow KA, et al. Tracheostomy in very low birth weight infants: a prospective multicenter study. Pediatrics. 2020;145:1–9.

    Article  Google Scholar 

  16. Murthy K, Porta NFM, Lagatta JM, Zaniletti I, Truog W, Grover T, et al. Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia. J Perinatol. 2017;37:723–7.

    Article  CAS  Google Scholar 

  17. Mandy G, Malkar M, Welty SE, Brown R, Shephard E, Gardner W, et al. Tracheostomy placement in infants with bronchopulmonary dysplasia: safety and outcomes. Pediatr Pulmonol. 2013;48:245–9.

    Article  Google Scholar 

  18. Demauro SB, D’Agostino JA, Bann C, Bernbaum J, Gerdes M, Bell E, et al. Developmental outcomes of very preterm infants with tracheostomies. J Pediatr. 2014;164:1303–10.

    Article  Google Scholar 

  19. Khemani E, McElhinney DB, Rhein L, Andrade O, Lacro R, Thomas K, et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics. 2007;120:1260–9.

    Article  Google Scholar 

  20. Mathew R. Signaling pathways in the development of bronchopulmonary dysplasia and pulmonary hypertension. Children. 2020;7:100. https://doi.org/10.3390/children7080100.

    Article  PubMed Central  Google Scholar 

  21. Dh Kim, Kim HS, Choi CW, Kim EK, Kim B, Choi JH. Risk factors for pulmonary artery hypertension in preterm infants with moderate to severe bronchopulmonary dysplasia. Neonatology. 2012;101:40.

    Article  Google Scholar 

  22. Farquhar M, Fitzgerald DA. Pulmonary hypertension in chronic neonatal lung disease. Pediatr Respir Rev. 2010;11:149.

    Article  Google Scholar 

  23. Nyp MF, Taylor JB, Petralia A, Oschman A, Norberg M, Weatherly R, et al. Acute post-tracheostomy clinical decompensation in infants-are there predictive markers? Am J Perinatol. 2018;35:1206–12.

    Article  Google Scholar 

  24. Gien J, Kinsella J, Thrasher J, Grenolds A, Abman S, Baker C. Retrospective analysis of an interdisciplinary ventilator care program intervention on survival of infants with ventilator-dependent bronchopulmonary dysplasia. Am J Perinatol. 2017;34:155–63.

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge all the members of the Chronic Lung Disease multidisciplinary team for their dedication to our BPD/CLD patients. The authors also thank the Children’s Mercy Medical Writing Center for reviewing and editing this manuscript.

Author information

Authors and Affiliations

  1. Division of Neonatology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Taylor P. Hansen, Michael Norberg, William Truog & Winston Manimtim

  2. Health Services and Outcome Research, Children’s Mercy Kansas City, Kansas City, MO, USA

    Janelle Noel-MacDonnell

  3. School of Medicine, University of Missouri-Kanas City, Kansas City, MO, USA

    Janelle Noel-MacDonnell, William Truog & Winston Manimtim

  4. School of Medicine, University of Kansas, Lawrence, KS, USA

    Sara Kuckelman

Authors
  1. Taylor P. Hansen
    View author publications

    Search author on:PubMed Google Scholar

  2. Janelle Noel-MacDonnell
    View author publications

    Search author on:PubMed Google Scholar

  3. Sara Kuckelman
    View author publications

    Search author on:PubMed Google Scholar

  4. Michael Norberg
    View author publications

    Search author on:PubMed Google Scholar

  5. William Truog
    View author publications

    Search author on:PubMed Google Scholar

  6. Winston Manimtim
    View author publications

    Search author on:PubMed Google Scholar

Contributions

TPH and SK collected data with supervision from WM, MN provided the history of CLD team and the patient repository. JN-M performed statistics, figures, and tables. TPH, JN-M, and WM wrote the manuscript in consultation with MN, WT and SK.

Corresponding author

Correspondence to Winston Manimtim.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hansen, T.P., Noel-MacDonnell, J., Kuckelman, S. et al. A multidisciplinary chronic lung disease team in a neonatal intensive care unit is associated with increased survival to discharge of infants with tracheostomy. J Perinatol 41, 1963–1971 (2021). https://doi.org/10.1038/s41372-021-00974-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-021-00974-2

This article is cited by

Search

Advanced search

Quick links