Evaluation of Trends in Bronchopulmonary Dysplasia and Respiratory Support Practice for Very Low Birth Weight Infants: A Population-Based Cohort Study

Lee, Soon Min; Sie, Lillian; Liu, Jessica; Profit, Jochen; Lee, Henry

doi:10.1016/j.jpeds.2021.11.049

Cited by 30 publications

(23 citation statements)

References 30 publications

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“…In addition, our study showed that the median time to extubation was 9 days in hydrocortisone-treated infants compared with 15 days in the placebo group. In line with recently published population-based observational studies, this reduction in the duration of mechanical ventilation did not result in a decrease of BPD incidence 15 16. However, shortening invasive ventilation by 6 days may have important implications as retrospective cohort studies have shown that each additional day of mechanical ventilation was negatively correlated with long-term neurodevelopmental impairment 17 18…”

Section: Discussionsupporting

confidence: 81%

Short-term pulmonary and systemic effects of hydrocortisone initiated 7–14 days after birth in ventilated very preterm infants: a secondary analysis of a randomised controlled trial

Halbmeijer

Onland

Cools

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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ObjectiveObservational studies in preterm infants suggest that systemic hydrocortisone improves pulmonary condition but may also lead to systemic adverse effects. We report the short-term pulmonary and systemic effects of hydrocortisone initiated in the second week.DesignRandomised placebo-controlled trial.SettingDutch and Belgian neonatal intensive care units.PatientsInfants born <30 weeks’ gestation and/or birth weight <1250 g, and ventilator dependent in the second week of life.InterventionInfants were randomly assigned to a 22-day course of systemic hydrocortisone (cumulative dose 72.5 mg/kg; n=182) or placebo (n=190).Main outcome measuresData on extubation, ventilator settings, glucose levels, and blood pressure were recorded daily and analysed during the first 7 days of treatment using linear mixed-effects models.ResultsInfants in the hydrocortisone group (24.3%) failed extubation less often compared with placebo (38.6%, crude risk difference: −14.3% (95% CI: −23.4% to −4.8%)). The estimated difference in daily rate of change between hydrocortisone and placebo was −0.42 cmH2O (95% CI: −0.48 to −0.36) for mean airway pressure, −0.02 (95% CI: −0.02 to −0.01) for fraction of inspired oxygen, −0.37 (95% CI: −0.44 to −0.30) for respiratory index, 0.14 mmol/L (95% CI: 0.08 to 0.21) for blood glucose levels and 0.83 mm Hg (95% CI: 0.58 to 1.09) for mean blood pressure.ConclusionsSystemic hydrocortisone initiated between 7 and 14 days after birth in ventilated preterm infants improves pulmonary condition, thereby facilitating weaning and extubation from invasive ventilation. The effects of hydrocortisone on blood glucose levels and blood pressure were mild and of limited clinical relevance.Trial registration numberNetherlands Trial Register (NTR2768; https://www.trialregister.nl/trial/2640) and European Union Clinical Trials Register (EudraCT, 2010-023777-19).

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Section: Discussionsupporting

confidence: 81%

Short-term pulmonary and systemic effects of hydrocortisone initiated 7–14 days after birth in ventilated very preterm infants: a secondary analysis of a randomised controlled trial

Halbmeijer

Onland

Cools

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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“…Over the last two decades, survival without significant morbidity among very low birthweight (VLBW) infants has improved ( 1 , 2 ). Steady decreases in the rate of morbidities such as severe intraventricular hemorrhage, retinopathy of prematurity, late onset sepsis, and necrotizing enterocolitis have been observed, yet rates of bronchopulmonary dysplasia (BPD) have remained consistent ( 1 – 3 ). Despite critical advances in treating respiratory distress syndrome (RDS) and BPD, almost half of surviving extremely preterm infants will develop BPD.…”

Section: Introductionmentioning

confidence: 99%

Respiratory support strategies in the prevention of bronchopulmonary dysplasia: A single center quality improvement initiative

et al. 2022

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Background and objectivesBronchopulmonary dysplasia (BPD) continues to be a significant morbidity affecting very preterm infants, despite multiple advancements in therapies to treat respiratory distress syndrome and prevent BPD. Local quality improvement (QI) efforts have shown promise in reducing unit or system-wide rates of BPD. In preterm infants born between 23- and 32-weeks' gestation, our aim was to decrease the rate of BPD at 36 weeks corrected gestational age from 43% to 28% by January 2019.MethodsDirected by a multidisciplinary respiratory QI team, we gradually implemented the following interventions to reach our aim: (1) early initiation of non-invasive ventilation in the delivery room, (2) initiation of caffeine prior to 24 h of life, (3) administration of early selective surfactant per a well-defined guideline, (4) continuation of non-invasive ventilation until 32 and 0/7 weeks corrected gestational age (CGA), and (5) a revision of the early selective surfactant guideline. Outcome measures included rates of BPD, and process measures included compliance with the above interventions.ResultsA total of 509 infants with an average gestational age of 29 1/7 weeks and birth weight of 1,254 (SD±401) grams were included. The rate of BPD in our unit decreased from a baseline of 43% to 19% from the start of the project in October 2016 until the first quarter of 2022 (p < 0.00001). The greatest reductions in BPD rates were seen after the initiation of the guideline to extend non-invasive ventilation until 32 0/7 weeks CGA. The rate of severe BPD decreased from 22% to 9%.ConclusionsIn preterm infants born between 23- and 32-weeks' gestation, our local QI interventions to reduce rates of BPD were associated with a reduction in rates by 56%. Increased use of antenatal steroids and higher birth weights post- vs. pre-intervention may have contributed to this successes.

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“…Exposure to mechanical ventilation is among the strongest known postnatal risk factors for the development of BPD. 8,14 However, data from large observational studies indicate that decreased use of invasive mechanical ventilation, including the 15%-20% absolute reduction documented by Lee et al, has not been accompanied by similar reductions in BPD rates or improvements in respiratory function in later childhood. 8,15,16 These observations call into question whether clinical care paradigms that focus primarily on reducing exposure to invasive mechanical ventilation and supplemental oxygen can successfully prevent BPD in a majority of infants born extremely preterm.…”

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confidence: 99%

“…[5][6][7] In this volume of The Journal, Lee et al provide recent data that add to this growing body of literature. 8 The authors report on trends in respiratory care practices, survival, and BPD rates in a cohort of more than 40 000 infants born with gestational ages <32 weeks or birth weights of 400-1500 g in California between 2008 and 2017. Unfortunately, rates of BPD, defined as supplemental oxygen use at 36 weeks' postmenstrual age (PMA), were largely unchanged during this 10-year period.…”

mentioning

confidence: 99%

“…To achieve this desired goal, Lee et al call for new quality improvement initiatives. 8 Unfortunately, such efforts have produced inconsistent results and raise doubts that increased use of currently available, evidencebased therapies can yield further reductions in BPD rates. 10,11 Moreover, periods marked by dramatic fluctuation in the use of therapies shown to lower BPD risk in randomized trials have not translated into clear changes in BPD incidence.…”

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confidence: 99%

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Reduction in Mechanical Ventilation: Necessary but Not Sufficient to Prevent Bronchopulmonary Dysplasia in Infants Born Extremely Preterm?

Jensen

DeMauro

2022

The Journal of Pediatrics

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Evaluation of Trends in Bronchopulmonary Dysplasia and Respiratory Support Practice for Very Low Birth Weight Infants: A Population-Based Cohort Study

Cited by 30 publications

References 30 publications

Short-term pulmonary and systemic effects of hydrocortisone initiated 7–14 days after birth in ventilated very preterm infants: a secondary analysis of a randomised controlled trial

Short-term pulmonary and systemic effects of hydrocortisone initiated 7–14 days after birth in ventilated very preterm infants: a secondary analysis of a randomised controlled trial

Respiratory support strategies in the prevention of bronchopulmonary dysplasia: A single center quality improvement initiative

Reduction in Mechanical Ventilation: Necessary but Not Sufficient to Prevent Bronchopulmonary Dysplasia in Infants Born Extremely Preterm?

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