Medication use in infants with severe bronchopulmonary dysplasia admitted to United States children’s hospitals

Bamat, Nicolas A.; Kirpalani, Haresh; Feudtner, Chris; Jensen, Erik A.; Laughon, Matthew M.; Zhang, Huayan; Monk, Heather M.; Passarella, Molly; Lorch, Scott A.

doi:10.1038/s41372-019-0415-9

Cited by 49 publications

(35 citation statements)

References 27 publications

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“…Compared with our findings of 48% of severe BPD patients receiving an IB, Bamat et al, using the PHIS database to study cumulative medicine exposures in severe BPD patients between 2007 and 2016, found that 38% of infants with severe BPD were exposed to albuterol [17]. Similar to our results, another study demonstrated significant variability in IB use, showing that the point SGA small for gestational age, IVH intraventricular hemorrhage, PDA patent ductus arteriosus.…”

Section: Discussionsupporting

confidence: 84%

“…The paucity of data surrounding the indications, timing of use, and effectiveness of IBs in managing symptoms of BPD, as well as concerns for adverse effects, have likely led to the wide variation in IB exposure in infants with developing or established BPD [11,17]. For those with BPD, and especially severe BPD, the extent of IB use and the factors related to IB use are incompletely understood.…”

Section: Introductionmentioning

confidence: 99%

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Inhaled bronchodilator exposure in the management of bronchopulmonary dysplasia in hospitalized infants

et al. 2020

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Objective To determine clinical, demographic, and hospital factors associated with inhaled bronchodilator (IB) use in infants with bronchopulmonary dysplasia (BPD) and specifically severe BPD. Study design Retrospective multicenter cohort study of 4986 infants born <32 weeks gestation with developing BPD at 28 days of life. We used the Pediatric Health Information System database to compare hospital experience and the demographic and clinical characteristics of infants exposed and not exposed to IBs. Results Twenty-five percent of BPD patients (1224/4986) and 48% of severe BPD patients (664/1390) received IBs. IB exposure was higher in infants with the tracheostomy, prolonged steroid and diuretic exposure, and longer duration of respiratory support. IB use varied markedly between hospitals (0-59%). Average annual BPD census was not associated with IB use. Conclusion Bronchodilator exposure is common in BPD patients with substantial variability in its use. Hospital experience did not account for the between-hospital variation in practice.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Inhaled bronchodilator exposure in the management of bronchopulmonary dysplasia in hospitalized infants

et al. 2020

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“…The PROP study demonstrated the importance of contemporary diagnostic criteria and definitions for BPD . There is an equally compelling need to evaluate the effectiveness of commonly used medications for respiratory conditions in the NICU, ideally through robust randomized clinical trials . Well‐defined dosing criteria and risk/benefit evaluation are necessary for well‐designed trials.…”

Section: Resultsmentioning

confidence: 99%

Respiratory medication use in extremely premature (<29 weeks) infants during initial NICU hospitalization: Results from the prematurity and respiratory outcomes program

Greenberg

Poindexter

Shaw

et al. 2019

Pediatric Pulmonology

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Background The use of medications to treat respiratory conditions of extreme prematurity is often based upon studies of adults or children over 2 years of age. Little is known about the spectrum of medications used or dosing ranges. To inform the design of future studies, we conducted a prospective analysis of respiratory medication exposure among 832 extremely low gestational age neonates. Methods The prematurity and respiratory outcomes program (PROP) enrolled neonates less than 29‐week gestation from 6 centers incorporating 13 clinical sites. We collected recorded daily “respiratory” medications given along with dosing information through 40‐week postmenstrual age or neonatal intensive care unit discharge if earlier. Results PROP participants were exposed to a wide range of respiratory medications, often at doses beyond published recommendations. Nearly 50% received caffeine and furosemide beyond published recommendations for cumulative dose. Those who developed bronchopulmonary dysplasia were more likely to receive treatment with respiratory medications. However, more than 30% of PROP subjects that did not develop bronchopulmonary dysplasia also were treated with diuretics, systemic steroids, and other respiratory medications. Conclusion Extremely preterm neonates in PROP were exposed to high doses of medications at levels known to generate significant adverse effects. With limited evidence for efficacy, there is an urgent need for controlled trials in this vulnerable patient population.

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“…Therefore, controlled trials are urgently needed for examining the use of both inhaled and oral medications in this high-risk populations. 15 – 17 …”

Section: Discussionmentioning

confidence: 99%

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

et al. 2020

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Background Outcome of infants with tracheostomy have not been well described in the literature. Our objective was to describe the respiratory, growth, and survival outcomes of infants with tracheostomy. Methods A retrospective study was conducted on 204 infants born between 2005 and 2015 with tracheostomy at <1 year of age and follow-up in the Infant Tracheostomy and Home Ventilator Clinic up to 4 years of age. Results The mean age at tracheostomy was 4.5 months with median age of 3 months. Median age of decannulation was 32 months. The time from tracheostomy placement to complete discontinuation of mechanical ventilation was 15.4 months and from tracheostomy to decannulation was 33.8 months. Mortality rate was 21% and median age of death was 18 months. Preterm infants with acquired airway and lung disease (BPD) and born at <28 weeks’ gestation had a significantly higher survival rate compared to term infants. The z -scores for weight and weight for length improved from the time of discharge (mean chronological age 6.5 months) to first year and remained consistent through 3 years. Conclusions Premature infants had a higher rate of discontinuation of mechanical ventilation and decannulation compared to term infants. These infants showed consistent growth and comparable survival rate. Impact Infants with tracheostomy and ventilator dependence followed in a multidisciplinary clinic model may have improved survival, growth, and earlier time to decannulation. Preterm infants with acquired airway and lung disease (BPD) with tracheostomy had a higher survival rate compared to term infants with various tracheostomy indications. The age at tracheostomy in infants was 4.5 months and of decannulation was 37 months. Time from tracheostomy to complete discontinuation of mechanical ventilation was 15.4 months. Addition of this data to the sparse literature will be crucial in counseling the families and education of medical staff.

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Medication use in infants with severe bronchopulmonary dysplasia admitted to United States children’s hospitals

Cited by 49 publications

References 27 publications

Inhaled bronchodilator exposure in the management of bronchopulmonary dysplasia in hospitalized infants

Inhaled bronchodilator exposure in the management of bronchopulmonary dysplasia in hospitalized infants

Respiratory medication use in extremely premature (<29 weeks) infants during initial NICU hospitalization: Results from the prematurity and respiratory outcomes program

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

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