The Effect of Noninvasive Positive Pressure Ventilation on Pneumonia Hospitalizations in Children With Neurological Disease

Abstract

The aim of this retrospective single-institution observational study was to identify whether the frequency of hospitalizations for pneumonia would change before and after the initiation of noninvasive positive pressure ventilation in children with neurological conditions. Included patients were 1 to 18 years old with an underlying neurological disease and had been prescribed nocturnal noninvasive positive pressure ventilation. The authors excluded patients with a tracheostomy or those who used noninvasive positive pressure ventilation solely for obstructive sleep apnea. A total of 14 patients were included in the study, among whom there was no significant change in the mean number of pneumonias 2 years before versus after the initiation of noninvasive positive pressure ventilation (mean difference = −0.714, standard deviation = 2.4, P = .312). These findings suggest that while noninvasive positive pressure ventilation may not reduce absolute pneumonia frequency, it may have the beneficial value of preventing an increase in the frequency of pneumonias over time, especially in children with progressive respiratory compromise.

ERS statement on paediatric long-term noninvasive respiratory support

“…Literature review (Online Table 5.4) Due to ethical constraints, the benefits on NIV have not been confirmed in randomized controlled trials and the published cohort studies mainly consist of a limited number of patients. NIV is associated with: o an increase in survival in patients with SMA type 1 [57,62,65,66,209] and Duchenne muscular dystrophy [71,210] o fewer hospitalizations in patients with SMA type 1 [57,61,62,64,209], and some NMD [211,212]); but no change in hospitalizations in other children with NMD [213] o improvement in SDB symptoms in patients with SMA type 2-3 [60], infantile Pompe disease [73], and other NMD [69,82,84] o improvement in nocturnal and daytime gas exchange in patients with juvenile Pompe disease [72], and NMD [82] o improvement in sleep quality/architecture and cyclic-alternating patterns in patients with SMA type 1-2 [60], SMA type 2 [214], and other NMD [69,82] o decrease in chest deformity in patients with SMA type 1 [58,63], and SMA type 1-3 [61] o transient improvement in predicted FVC and thoraco-abdominal asynchrony in patients with Duchenne muscular dystrophy [215] o improvement in cardiac function in patients with Duchenne muscular dystrophy [216] o improvement in QoL in children with NMD [217].…”