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Long-term respiratory and developmental outcomes in children with bronchopulmonary dysplasia and history of tracheostomy

Journal of Perinatology volume 41, pages 2645–2650 (2021)Cite this article

Subjects

Abstract

Objective

The long-term morbidity among children with severe bronchopulmonary dysplasia who require tracheostomy (tBPD) relative to those without tracheostomy (sBPD) is not well characterized. We compared childhood lung function and neurodevelopmental outcomes in tBPD and sBPD.

Study design

Retrospective case-control study of N = 49 tBPD and N = 280 sBPD subjects in Boston Children’s Hospital Preterm Lung Patient Registry and medical record. We compared NICU course, childhood spirometry, and neurodevelopmental testing.

Result

tBPD subjects were more likely than sBPD to be Black, have pulmonary hypertension, and have subglottic stenosis. tBPD subjects had lower maximal childhood FEV1 % predicted (β = −0.14) and FEV1/FVC (β = −0.08); spirometry curves were more likely to suggest fixed extrathoracic obstruction. tBPD subjects had greater cognitive and motor delays <24 months, and greater cognitive delays >24 months.

Conclusion

Compared to subjects with sBPD who did not require tracheostomy, tBPD subjects suffer from increased long-term impairment in respiratory function and neurodevelopment.

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Fig. 1: Distribution of neurodevelopmental testing scores in BPD subjects with and without history of tracheostomy based on corrected gestational age.

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References

  1. Abman SH, Collaco JM, Shepherd EG, Keszler M, Cuevas-Guaman M, Welty SE, et al. Interdisciplinary care of children with severe bronchopulmonary dysplasia. J Pediatr. 2017;181:12–28. e11

    Article  Google Scholar 

  2. Sakai M, Kou YF, Shah GB, Johnson RF. Tracheostomy demographics and outcomes among pediatric patients ages 18 years or younger-United States 2012. Laryngoscope. 2019;129:1706–11.

    Article  Google Scholar 

  3. Koltsida G, Konstantinopoulou S. Long term outcomes in chronic lung disease requiring tracheostomy and T chronic mechanical ventilation. Semin Fetal Neonatal Med. 2019;24:101044.

  4. Pereira KD, MacGregor AR, McDuffie CM, Mitchell RB. Tracheostomy in preterm infants: current trends. Arch Otolaryngol Head Neck Surg. 2003;129:1268–71.

    Article  Google Scholar 

  5. Higgins RD, Jobe AH, Koso-Thomas M, Bancalari E, Viscardi RM, Hartert TV, et al. Bronchopulmonary dysplasia: executive summary of a workshop. J Pediatr. 2018;197:300–8.

    Article  Google Scholar 

  6. Wu KY, Jensen EA, White AM, Wang Y, Biko DM, Nilan K, et al. Characterization of disease phenotype in very preterm infants with severe bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2020;201:1398–406.

    Article  Google Scholar 

  7. Keller RL, Feng R, DeMauro SB, Ferkol T, Hardie W, Rogers EE, et al. Bronchopulmonary dysplasia and perinatal characteristics predict 1-year respiratory outcomes in newborns born at extremely low gestational age: a prospective cohort study. J Pediatr. 2017;187:89–97. e83

    Article  Google Scholar 

  8. Fawke J, Lum S, Kirkby J, Hennessy E, Marlow N, Rowell V, et al. Lung function and respiratory symptoms at 11 years in children born extremely preterm: the EPICure study. Am J Respir Crit Care Med. 2010;182:237–45.

    Article  Google Scholar 

  9. Vom Hove M, Prenzel F, Uhlig H, Robel-Tillig E. Pulmonary outcome in former preterm, very low birth weight children with bronchopulmonary dysplasia: a case-control follow-up at school age. J Pediatr. 2014;164:40–45. e44

    Article  Google Scholar 

  10. Verheggen M, Wilson A, Pillow J, Stick S, Hall G. Respiratory function and symptoms in young preterm children in the contemporary era. Pediatr Pulmonol. 2016;51:1347–55.

    Article  Google Scholar 

  11. Kaslovsky R, Sadof M. Spirometry for the primary care pediatrician. Pediatrics Rev. 2014;35:465–75.

    Article  Google Scholar 

  12. Brumbaugh JE, Bell EF, Grey SF, DeMauro SB, Vohr BR, Harmon HM, et al. Behavior profiles at 2 years for children born extremely preterm with bronchopulmonary dysplasia. J Pediatr. 2020;219:152–9.

    Article  Google Scholar 

  13. Cammack B, Noel-MacDonnell J, Cuna A, Manimtim W. Impact of tracheostomy on language and cognitive development in infants with severe bronchopulmonary dysplasia. J Perinatol. 2020;40:299–305.

    Article  CAS  Google Scholar 

  14. Cristea AI, Carroll AE, Davis SD, Swigonski NL, Ackerman VL. Outcomes of children with severe bronchopulmonary dysplasia who were ventilator dependent at home. Pediatrics. 2013;132:e727–734.

    Article  Google Scholar 

  15. Levin JC, Sheils CA, Gaffin JM, Hersh CP, Rhein LM, Hayden LP. Lung function trajectories in former premature infants: identifying risk factors for abnormal lung growth. Respir Res. 2021;22:143.

  16. Goryachev S, Sordo M, Zeng QT. A suite of natural language processing tools developed for the I2B2 project. AMIA Annu Symp Proc. 2006;2006:931.

    PubMed Central  Google Scholar 

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

    Article  CAS  Google Scholar 

  18. HoundDog. Research computing. Boston: Boston Children’s Hospital; 2018.

  19. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.

    Article  CAS  Google Scholar 

  20. Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324–43.

    Article  Google Scholar 

  21. Bayley N. Bayley scales of infant and toddler development. 3rd ed. San Antonio, TX: Harcourt Assessment; 2006.

  22. Corp. I IBM SPSS Statistics for Macintosh. 26.0 ed. Armonk, NY: IBM Corp.; 2018.

  23. Carron JD, Derkay CS, Strope GL, Nosonchuk JE, Darrow DH. Pediatric tracheotomies: changing indications and outcomes. Laryngoscope. 2000;110:1099–104.

    Article  CAS  Google Scholar 

  24. Levit OL, Shabanova V, Bazzy-Asaad A, Bizzarro MJ, Bhandari V. Risk factors for tracheostomy requirement in extremely low birth weight infants. J Matern-Fetal Neonatal Med. 2018;31:447–52.

    Article  Google Scholar 

  25. Grundfast KM, Felizardo S, Camilon J, Barber CS, Pransky S, Fink R. Prospective study of subglottic stenosis in intubated neonates. Ann Otol Rhinol Laryngol. 1990;99:390–5.

    Article  CAS  Google Scholar 

  26. Lee JH, Smith PB, Quek MBH, Laughon MM, Clark RH, Hornik CP. Risk factors and in-hospital outcomes following tracheostomy in infants. J Pediatr. 2016;173:39–44.

    Article  Google Scholar 

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

    Article  Google Scholar 

  28. Stark AR, Eichenwald EC. Bronchopulmonary dysplasia: management. UpToDate 2019 February 7, 2019 [cited 2020 June 18]. Available from: https://www.uptodate.com.

  29. Guaman MC, Gien J, Baker CD, Zhang H, Austin ED, Collaco JM. Point prevalence, clinical characteristics, and treatment variation for infants with severe bronchopulmonary dysplasia. Am J Perinatol. 2015;32:960–7.

    Article  Google Scholar 

  30. Thoma ME, Drew LB, Hirai AH, Kim TY, Fenelon A, Shenassa ED. Black-White disparities in preterm birth: geographic, social, and health determinants. Am J Prev Med. 2019;57:675–86.

    Article  Google Scholar 

  31. Kavvadia V, Greenough A, Dimitriou G, Hooper R. Influence of ethnic origin on respiratory distress syndrome in very premature infants. Arch Dis Child Fetal Neonatal Ed. 1998;78:F25–28.

    Article  CAS  Google Scholar 

  32. Ryan RM, Feng R, Bazacliu C, Ferkol TW, Ren CL, Mariani TJ, et al. Black race is associated with a lower risk of bronchopulmonary dysplasia. J Pediatr. 2019;207:130–5. e132

    Article  Google Scholar 

  33. 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:e20192371.

  34. Sigurdson K, Mitchell B, Liu J, Morton C, Gould JB, Lee HC, et al. Racial/ethnic disparities in neonatal intensive care: a systematic review. Pediatrics. 2019;144:e20183114.

    Article  Google Scholar 

  35. Cristea AI, Ackerman VL, Swigonski NL, Yu Z, Slaven JE, Davis SD. Physiologic findings in children previously ventilator dependent at home due to bronchopulmonary dysplasia. Pediatr Pulmonol. 2015;50:1113–8.

    Article  Google Scholar 

  36. Contecin P, Narcy P. Size of endotracheal tube and neonatal acquired subglottic stenosis. Arch Otolaryngol Head Neck Surg. 1993;119:815–9.

    Article  Google Scholar 

  37. 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 

  38. Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB. Outcome at 2 years of age of infants from the DART study: a multicenter, international, randomized, controlled trial of low-dose dexamethasone. Pediatrics. 2007;119:716–21.

    Article  Google Scholar 

  39. Litt JS, Minich N, Taylor HG, Tiemeier H. The inter-relationships of extremely low birth weight, asthma, and behavior: a study of common cause, mediation, and moderation. Acad Pediatr. 2020;20:975–82.

    Article  Google Scholar 

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Acknowledgements

Lawrence M. Rhein, MD MPH, Department of Pediatrics, University of Massachusetts, Worcester, MA, United States.

Funding

Supported by the National Institutes of Health (NHLBI K23 HL136851 [to L.P.H.], NICHD K23 HD088695 [to J.S.L.], NLM T15LM007092 [to N. Gehlenborg])

Author information

Authors and Affiliations

  1. Boston University School of Medicine, Boston, MA, USA

    Chandler A. Annesi

  2. Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA, USA

    Jonathan C. Levin, Catherine A. Sheils & Lystra P. Hayden

  3. Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, USA

    Jonathan C. Levin & Jonathan S. Litt

  4. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Jonathan C. Levin, Jonathan S. Litt, Catherine A. Sheils & Lystra P. Hayden

  5. Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Lystra P. Hayden

Authors
  1. Chandler A. Annesi
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  2. Jonathan C. Levin
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  3. Jonathan S. Litt
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  4. Catherine A. Sheils
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  5. Lystra P. Hayden
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Contributions

C.A.A. worked on the design of the study, conducted the analysis and drafted the initial manuscript. J.C.L. aided with the conceptualization of the study, assisted with statistical analysis, and reviewed the manuscript. J.S.L. helped design the methodology and reviewed the manuscript. C.A.S. aided with investigation, provided resources, and reviewed the manuscript. L.P.H. provided supervision for the design, methodology, and analysis and provided multiple manuscript revisions.

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Correspondence to Lystra P. Hayden.

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Annesi, C.A., Levin, J.C., Litt, J.S. et al. Long-term respiratory and developmental outcomes in children with bronchopulmonary dysplasia and history of tracheostomy. J Perinatol 41, 2645–2650 (2021). https://doi.org/10.1038/s41372-021-01144-0

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