Correlation of the ventilatory needs of infants with CLD of prematurity
with the existence of pulmonary hypertension- A single centre10 year
observational study
Abstract
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.