Objective: During the past two decades an increased survival of ex preterm infants has been observed 18. This is due to the improvement in neonatal care and due to the contribution of the ongoing evolving field of long term ventilation, invasive and non invasive 18. As per National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report the number of children and young people reported to be receiving LTV in the UK increased from 1 in 1975 to almost 1,400 in 2013 6.9% patients on LTV were due to chronic respiratory diseases and within that group,34.4% related to prematurity . 6Preterm infants with Chronic Lung Disease (CLD)or bronchopulmonary dysplasia (BPD)require ventilatory support for long periods and thus they may be discharged home on long term ventilation. Their clinical status may be also complicated by pulmonary hypertension. Aim: In this observational study we aim to describe the course of resolution of pulmonary hypertension in ex premature infants on long term ventilation –invasive or non-invasive, due to severe bronchopulmonary dysplasia (BPD) and assess if there is any difference in the timeframe of weaning off the ventilation between the group of ex premature infants with and without pulmonary hypertension. Design, Setting and Patients: We conducted a retrospective analysis of the long-term ventilation (LTV) database held within the Evelina London Children´s Hospital paediatric respiratory department. The interval analysis was between August 2011 to August 2021. We screened 360 children on LTV in order to identify preterm (<37-week gestational age) infants. We have described this cohort for their demographic characteristics, comorbidities, ventilatory interface, ventilation needs and weaning course and the presence or not of pulmonary hypertension Results: The majority of the patients needed bilevel ventilation (BiPAP). (BiPAP/CPAP ratio: 37/11). 22 out of 48 patients on LTV were liberated from their ventilators at the time of the study, the cohort on NIV had better outcomes than the tracheostomy cohort but this is mostly related to less severe BPD. Pulmonary hypertension has resolved for all patients apart from 3. Conclusion: Ex premature infants with BPD and pulmonary hypertension have good chances to be weaned off ventilation and that their pulmonary hypertension will resolve NIV patient progress better than those ventilated via tracheostomy. More research is needed in this field in order to investigate further the correlation of pulmonary hypertension and ventilatory needs and vice versa in this group of patients.

Objective: There has been a rise in the prenatal detection of right sided aortic arch (RAA). When associated with a left-sided arterial duct (LD), this forms a vascular ring encircling the trachea. Infants may have symptoms or signs suggestive of trache-oesophageal compression but many are asymptomatic. The objective of this study was to investigate the relationship between symptoms and severity of tracheo-bronchial compression assessed by bronchoscopy. Methods: Retrospective review of all cases of prenatally diagnosed RAA-LD in the absence of associated congenital heart disease at Evelina London Children’s Hospital and Kings College Hospital over a 4-year period between April 2015-2019. Clinical records, fetal echocardiograms and free-breathing flexible bronchoscopy (FB) data were reviewed. Results: 112 cases of isolated RAA-LD were identified of whom 82 cases (73%) underwent FB. FB was performed median age of 11 months (range 1-36 months), no complications occurred. Aberrant left subclavian artery (ALSA) was present in 86% (96/112) and mirror image branching (MIB) in 13% (15/112). 34/112 (30%) reported symptoms during follow up. 36/77 (47%) with ALSA who underwent FB showed moderate-severe compression mostly at distal tracheal and carinal level of whom 38% had parent-reported symptoms. Moderate-severe compression was seen in 3/5 (60%) with MIB mostly at mid tracheal level of whom 3 were symptomatic but only 2 with compression. In total 36% (18/50) of investigated asymptomatic patients showed moderate to severe compression. Respiratory symptoms were poorly predictive of moderate-severe compression (positive predictive value 66%). Conclusion: The absence of symptoms did not exclude significant tracheal compression. The anatomical effect of the vascular ring is underappreciated when symptoms alone are used as a marker of tracheal compression.