In-hospital outcomes of premature infants with severe bronchopulmonary dysplasia

Jackson, Wesley M.; Hornik, Christoph P.; Messina, Julia A.; Guglielmo, K; Watwe, A; Delancy, G; Valdez, Abner Daniel Aguilar; MacArthur, T; Peter-Wohl, Sigal; Smith, P. Brian; Tolia, Veeral N.; Laughon, Matthew M.

doi:10.1038/jp.2017.49

Cited by 16 publications

(21 citation statements)

References 25 publications

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“…Additionally these studies were performed on more mature infants [43] or infants suffering milder postnatal morbidities [20] compared to our group. We focused on preterm infants (<30 weeks gestation), and although babies with major morbidities were excluded, all of them experienced postnatal complications, in particular severe BPD and sepsis, potentially prolonging the time needed to acquire physiologic stability and full respiratory competency, which are mandatory for home discharge [44].…”

Section: Discussionmentioning

confidence: 99%

Effects of early intervention on feeding behavior in preterm infants: A randomized controlled trial

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et al. 2018

Early Human Development

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Section: Discussionmentioning

confidence: 99%

Effects of early intervention on feeding behavior in preterm infants: A randomized controlled trial

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et al. 2018

Early Human Development

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“…3 -8 As this population of CMC grows, there is a proportionate increase in the degree of intensive medical technology use, 2 and this may impart a trade-off in mortality for morbidity. 9,34 As an example, bronchopulmonary dysplasia has recently been associated with a 3% chance for survivors to be discharged from the hospital on mechanical ventilation, 39 commonly with HCN.…”

Section: Figurementioning

confidence: 99%

Home Health Care Availability and Discharge Delays in Children With Medical Complexity

et al. 2019

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BACKGROUND: An increasing proportion of pediatric hospital days are attributed to technologydependent children. The impact that a pediatric home care nursing (HCN) shortage has on increasing length of hospital stay and readmissions in this population is not well documented. METHODS: We conducted a 12-month multisite prospective study of children with medical complexity discharging with home health. We studied the following 2 cohorts: new patients discharging for the first time to home nursing and existing patients discharging from the hospital to previously established home nursing. A modified delay tool was used to categorize causes, delayed discharge (DD) days, and unplanned 90-day readmissions. RESULTS: DD occurred in 68.5% of 54 new patients and 9.2% of 131 existing patients. Lack of HCN was the most frequent cause of DD, increasing costs and directly accounting for an average length of stay increase of 53.9 days (range: 4-204) and 35.7 days (3-63) for new and existing patients, respectively. Of 1582 DDs, 1454 (91.9%) were directly attributed to lack of HCN availability. DD was associated with younger age and tracheostomy. Unplanned 90-day readmissions were due to medical setbacks (96.7% of cases) and occurred in 53.7% and 45.0% of new and existing patients, respectively. CONCLUSIONS: DD and related costs are primarily associated with shortage of HCN and predominantly affect patients new to HCN. Medical setbacks are the most common causes of unplanned 90-day readmissions. Increasing the availability of home care nurses or postacute care facilities could reduce costly hospital length of stay.

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“…The severity of BPD is defined by the level of respiratory support at 36 weeks postmenstrual age (PMA) [ 2 ]. Premature infants with severe BPD are particularly challenging to manage and often suffer from multiple complications and comorbidities, including prolonged hospitalization, need for home respiratory support, and death [ 3 – 5 ]. A common comorbidity in infants with severe BPD is pulmonary hypertension (PH).…”

Section: Introductionmentioning

confidence: 99%

Safety of sildenafil in premature infants with severe bronchopulmonary dysplasia (SILDI-SAFE): a multicenter, randomized, placebo-controlled, sequential dose-escalating, double-masked, safety study

et al. 2020

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Background Pulmonary hypertension is a deadly complication of bronchopulmonary dysplasia, the most common pulmonary morbidity of prematurity. Despite these catastrophic consequences, no evidence-based therapies are available for the prevention of pulmonary hypertension in this population. Sildenafil is a potent pulmonary vasodilator approved by the US Food and Drug Administration for the treatment of pulmonary hypertension in adults. Preclinical models suggest a beneficial effect of sildenafil on premature lungs through improved alveolarization and preserved vascular development. Sildenafil may therefore prevent the development of pulmonary hypertension associated with lung disease of prematurity by reducing pulmonary vascular remodeling and lowering pulmonary vascular resistance; however, clinical trial evidence is needed. The present study, supported by the National Institutes of Health’s National Heart Lung and Blood Institute, will generate safety, pharmacokinetics, and preliminary effectiveness data on sildenafil in a population of premature infants with severe bronchopulmonary dysplasia at risk for pulmonary hypertension. Methods We have designed a multicenter, randomized, placebo-controlled, sequential dose-escalating, double-masked, safety trial of sildenafil in premature infants with severe bronchopulmonary dysplasia. We will randomize 120 premature infants < 29 weeks gestational age with severe bronchopulmonary dysplasia at 32–40 weeks postmenstrual age in a dose-escalating approach 3:1 (sildenafil: placebo) sequentially into each of 3 cohorts at ~ 30 clinical sites. Participants will receive up to 34 days of study drug, followed by 28 days of safety monitoring. The primary outcome will be safety as determined by incidence of hypotension. Secondary outcomes will include pharmacokinetics and preliminary effectiveness of sildenafil based on presence or absence of pulmonary hypertension diagnosed by echocardiography at the end of treatment period. Discussion Sildenafil is a promising intervention to prevent the development of pulmonary hypertension in premature infants with bronchopulmonary dysplasia. Clinical trials of sildenafil specifically designed for premature infants are urgently needed. The current study will make substantial contributions to scientific knowledge of the safety of sildenafil in premature infants at risk for pulmonary hypertension. Results from the study will be used by investigators to inform the design of a pivotal efficacy trial. Trial registration ClinicalTrials.govNCT04447989. Registered 25 June 2020.

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In-hospital outcomes of premature infants with severe bronchopulmonary dysplasia

Cited by 16 publications

References 25 publications

Effects of early intervention on feeding behavior in preterm infants: A randomized controlled trial

Effects of early intervention on feeding behavior in preterm infants: A randomized controlled trial

Home Health Care Availability and Discharge Delays in Children With Medical Complexity

Safety of sildenafil in premature infants with severe bronchopulmonary dysplasia (SILDI-SAFE): a multicenter, randomized, placebo-controlled, sequential dose-escalating, double-masked, safety study

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