| Description: |
Rationale: Despite preventive efforts, many infants still develop severe bronchopulmonary dysplasia (sBPD) and require long-term invasive home mechanical ventilation (IHMV). Research on predictors of IHMV duration remains limited. This study aimed to identify predictors of IHMV duration in children with sBPD treated in a tertiary NICU in the southern United States. Methods: Following IRB approval, we included patients admitted from 2018-2024, born before 32 weeks gestation, diagnosed with grade 2-3 BPD (according to Jensen's definitions), and discharged on IHMV. The main outcome was time to liberation from IHMV following the initial discharge. We examined potential predictors, including demographics, birth characteristics, BPD severity indicators, comorbidities, and age at index discharge (both chronological and corrected for prematurity or tracheostomy). Kaplan-Meier curves were generated to illustrate time-to-liberation from IHMV, and multivariate Cox regression was used to assess associations between predictors and IHMV duration, estimating hazard ratios (HR) and 95% confidence intervals (CI). Results: Of 38 patients discharged on IHMV, 63.2% were male, 44.7% non-Hispanic White, and 79.0% had grade 3 BPD. The mean age at discharge was 13.72 months (SD = 3.68). Over half (57.9%) were liberated from IHMV during follow-up, with a median liberation time of 14.53 months (CI: 12.53, 17.27) post-discharge (see Fig. 1). Grade 3 BPD was associated with reduced time to liberation from IHMV (HR = 5.893, CI = 1.130, 30.728, p = 0.0353). A potential association was observed with respiratory severity score (MAP x FiO2) at discharge from the NICU to a medical unit (HR = 0.546, CI = 0.298, 1.001, p = 0.0502). No associations were found between IHMV duration and demographic or birth characteristics, comorbidities, or corrected index discharge age. Conclusions: Our findings suggest that time to IHMV liberation varies based on indicators of BPD severity, including Jensen's grading and respiratory severity score at NICU ... |