Decannulation delayed by chronic neurological conditions in preemies with BPD

Chronic neurologic conditions delay the time to tracheostomy decannulation among premature infants with severe bronchopulmonary dysplasia (BPD), a new study has found.

Researchers retrospectively assessed 93 premature infants who had BPD or chronic lung disease of prematurity. Relevant information was retrieved from electronic medical records. All participants had tracheostomy and ventilator dependence. The primary outcome of interest was time to decannulation.

Tracheostomy placement was performed at an average age of 148 days and was subsequently removed at a mean age of 3.3±1.12 years in 66 patients. One patient was recannulated following failures of extubation during single-stage airway reconstruction; another patient died during the study.

Participants were then categorized according to clinical risk factors: 25 percent (n=23) required airway reconstruction, 24 percent (n=22) had pulmonary hypertension, 15 percent (n=14) had a chronic neurological condition, and 20 percent (n=19) had all three risk factors; 16 percent (n=15), on the other hand, had none of the above.

Of all the risk categories, patients with chronic neurological conditions alone saw the longest time to decannulation, at a median day count of 1,428. In comparison, the median time to decannulation in patients without any risk factor was only 1,074 days.

Multivariable analysis confirmed that having a chronic neurological condition significantly delayed the time to decannulation (hazard ratio, 0.3, 95 percent confidence interval, 0.09–0.98). None of the other risk groups achieved significance.

“Understanding the driving factor for this association will allow clinicians to provide families with more informed guidance as they navigate the complex process of long-term mechanical ventilation,” the researchers said. “Future studies prospectively assessing the role and interplay of modifiable and nonmodifiable factors are needed to identify areas for improvement in care.”