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Long-Term Ventilator Support in Bronchopulmonary Dysplasia

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Caring for the Ventilator Dependent Child

Part of the book series: Respiratory Medicine ((RM))

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Abstract

Bronchopulmonary dysplasia (BPD) is a common cause of chronic lung disease in infants born prematurely (<37 weeks gestation) and is associated with high morbidity, particularly during the first 2 years of life. The diagnosis of BPD is given to preterm infants who require supplemental oxygen for at least the first 28 days of life. Infants who are diagnosed with severe BPD have an oxygen requirement of greater than 30 % and/or the need for positive pressure ventilation at 36 weeks post-conceptual age or at discharge. Infants with severe BPD are most likely to have persistent respiratory failure requiring home invasive ventilation. Risk of death in children on home mechanical ventilation is high despite current monitoring technology.

BPD is formally defined on the basis of anoxygen requirement at specific post-conceptual time points, but this measure does not capture the spectrum of respiratory phenotypes that encompass BPD. Infants and children may have varying combinations of parenchymal, vascular, small airway and large airway disease. The protean manifestations of BPD frequently require tailoring and frequent assessment of ventilator management and other respiratory care on the individual level. The strategies used to ventilate a child in chronic respiratory failure with BPD will likely need to be modulated based on the presenting combination of respiratory phenotypes.

This chapter covers the epidemiology of BPD and those who require long-term ventilation as well manifestations of disease, strategies for ventilation as well as weaning ventilation, the use of polysomnography, decannulation strategies, equipment needs, and comorbidities. Although the heterogeneity of lung disease and its various components of parenchymal, vascular, small airway and large airway disease make it challenging to manage, infants with BPD can be ventilated in the home setting effectively. Successful ventilation is dependent on caregiver training, appropriate resources, and availability of subspecialty care. Unlike many other pediatric respiratory diseases that may require home invasive ventilation, infants and children with BPD have a higher likelihood of being weaned from support with good lung growth.

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References

  1. Greenough A. Long-term pulmonary outcome in the preterm infant. Neonatology. 2008;93(4):324–7.

    Article  PubMed  Google Scholar 

  2. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163(7):1723–9.

    Article  CAS  PubMed  Google Scholar 

  3. Laughon MM, Langer JC, Bose CL, Smith PB, Ambalavanan N, Kennedy KA, et al. Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants. Am J Respir Crit Care Med. 2011;183(12):1715–22. Pubmed Central PMCID: 3136997.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hamilton BE, Hoyert DL, Martin JA, Strobino DM, Guyer B. Annual summary of vital statistics: 2010-2011. Pediatrics. 2013;131(3):548–58.

    Article  PubMed  Google Scholar 

  5. Sidman JD, Jaguan A, Couser RJ. Tracheotomy and decannulation rates in a level 3 neonatal intensive care unit: a 12-year study. Laryngoscope. 2006;116(1):136–9.

    Article  PubMed  Google Scholar 

  6. Sisk EA, Kim TB, Schumacher R, Dechert R, Driver L, Ramsey AM, et al. Tracheotomy in very low birth weight neonates: indications and outcomes. Laryngoscope. 2006;116(6):928–33.

    Article  PubMed  Google Scholar 

  7. Cristea AI, Carroll AE, Davis SD, Swigonski NL, Ackerman VL. Outcomes of children with severe bronchopulmonary dysplasia who were ventilator dependent at home. Pediatrics. 2013;132(3):e727–34. Pubmed Central PMCID: 3876749.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Joseph RA. Tracheostomy in infants: parent education for home care. Neonatal Network. 2011;30(4):231–42.

    Article  PubMed  Google Scholar 

  9. Boroughs D, Dougherty JA. Decreasing accidental mortality of ventilator-dependent children at home: a call to action. Home Healthc Nurse. 2012;30(2):103–11; quiz 12–3.

    PubMed  Google Scholar 

  10. Edwards JD, Kun SS, Keens TG. Outcomes and causes of death in children on home mechanical ventilation via tracheostomy: an institutional and literature review. J Pediatr. 2010;157(6):955–9. e2.

    Article  PubMed  Google Scholar 

  11. Thurlbeck WM. Postnatal human lung growth. Thorax. 1982;37(8):564–71. Pubmed Central PMCID: 459376.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Frank L, Sosenko IR. Undernutrition as a major contributing factor in the pathogenesis of bronchopulmonary dysplasia. Am Rev Respir Dis. 1988;138(3):725–9.

    Article  CAS  PubMed  Google Scholar 

  13. Lefton-Greif MA, McGrath-Morrow SA. Deglutition and respiration: development, coordination, and practical implications. Semin Speech Lang. 2007;28(3):166–79.

    Article  PubMed  Google Scholar 

  14. Thebaud B, Abman SH. Bronchopulmonary dysplasia: where have all the vessels gone? Roles of angiogenic growth factors in chronic lung disease. Am J Respir Crit Care Med. 2007;175(10):978–85. Pubmed Central PMCID: 2176086.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Hadchouel A, Franco-Montoya ML, Delacourt C. Altered lung development in bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol. 2014;100(3):158–67.

    Article  CAS  PubMed  Google Scholar 

  16. Abman SH. Impaired vascular endothelial growth factor signaling in the pathogenesis of neonatal pulmonary vascular disease. Adv Exp Med Biol. 2010;661:323–35.

    Article  CAS  PubMed  Google Scholar 

  17. Mourani PM, Abman SH. Pulmonary vascular disease in bronchopulmonary dysplasia: pulmonary hypertension and beyond. Curr Opin Pediatr. 2013;25(3):329–37.

    Article  CAS  PubMed  Google Scholar 

  18. Collaco JM, Romer LH, Stuart BD, Coulson JD, Everett AD, Lawson EE, et al. Frontiers in pulmonary hypertension in infants and children with bronchopulmonary dysplasia. Pediatr Pulmonol. 2012;47(11):1042–53. Pubmed Central PMCID: 3963167.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Farquhar M, Fitzgerald DA. Pulmonary hypertension in chronic neonatal lung disease. Paediatr Respir Rev. 2010;11(3):149–53.

    Article  PubMed  Google Scholar 

  20. Carmosino MJ, Friesen RH, Doran A, Ivy DD. Perioperative complications in children with pulmonary hypertension undergoing noncardiac surgery or cardiac catheterization. Anesth Analg. 2007;104(3):521–7. Pubmed Central PMCID: 1934984.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kim GB. Pulmonary hypertension in infants with bronchopulmonary dysplasia. Korean J Pediatr. 2010;53(6):688–93. Pubmed Central PMCID: 2994133.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Abman SH et al. Pediatric pulmonary hypertension: Guidelines from the American Heart Association and American Thoracic Society. Circulation. 2015 Nov 24;132(21):2037–99.

    Google Scholar 

  23. Mourani P, Mullen M, Abman SH. Pulmonary hypertension in bronchopulmonary dysplasia. Prog Pediatr Cardiol. 2009;27(1–2):43–8.

    Article  Google Scholar 

  24. Abman SH. Monitoring cardiovascular function in infants with chronic lung disease of prematurity. Arch Dis Child Fetal Neonatal Ed. 2002;87(1):F15–8. Pubmed Central PMCID: 1721426.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Dhillon R. The management of neonatal pulmonary hypertension. Arch Dis Child Fetal Neonatal Ed. 2012;97(3):F223–8.

    Article  PubMed  Google Scholar 

  26. Khemani E, McElhinney DB, Rhein L, Andrade O, Lacro RV, Thomas KC, et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics. 2007;120(6):1260–9.

    Article  PubMed  Google Scholar 

  27. Vrijlandt EJ, Gerritsen J, Boezen HM, Grevink RG, Duiverman EJ. Lung function and exercise capacity in young adults born prematurely. Am J Respir Crit Care Med. 2006;173(8):890–6.

    Article  PubMed  Google Scholar 

  28. Landry JS, Chan T, Lands L, Menzies D. Long-term impact of bronchopulmonary dysplasia on pulmonary function. Canad Respir J. 2011;18(5):265–70. Pubmed Central PMCID: 3267603.

    Article  Google Scholar 

  29. Wright CJ, Kirpalani H. Targeting inflammation to prevent bronchopulmonary dysplasia: can new insights be translated into therapies? Pediatrics. 2011;128(1):111–26. Pubmed Central PMCID: 3124103.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Doyle LW, Ehrenkranz RA, Halliday HL. Postnatal hydrocortisone for preventing or treating bronchopulmonary dysplasia in preterm infants: a systematic review. Neonatology. 2010;98(2):111–7.

    Article  CAS  PubMed  Google Scholar 

  31. Onland W, Offringa M, van Kaam A. Late (>/= 7 days) inhalation corticosteroids to reduce bronchopulmonary dysplasia in preterm infants. Cochrane Database Syst Rev. 2012;4, CD002311.

    PubMed  Google Scholar 

  32. ad hoc Statement Committee ATS. Mechanisms and limits of induced postnatal lung growth. Am J Respir Crit Care Med. 2004;170(3):319–43.

    Article  Google Scholar 

  33. Baraldi E, Filippone M. Chronic lung disease after premature birth. N Engl J Med. 2007;357(19):1946–55.

    Article  CAS  PubMed  Google Scholar 

  34. Sterni LM et al. An official American Thoracic Society clinical practice guideline: Pediatric chronic home invasive ventilation. Am J Respir Crit Care Med. 2016 Apr 15;193(8):e16–35.

    Google Scholar 

  35. Lee KS, Sun MR, Ernst A, Feller-Kopman D, Majid A, Boiselle PM. Comparison of dynamic expiratory CT with bronchoscopy for diagnosing airway malacia: a pilot evaluation. Chest. 2007;131(3):758–64.

    Article  PubMed  Google Scholar 

  36. Kim DH, Kim HS, Choi CW, Kim EK, Kim BI, Choi JH. Risk factors for pulmonary artery hypertension in preterm infants with moderate or severe bronchopulmonary dysplasia. Neonatology. 2012;101(1):40–6.

    Article  PubMed  Google Scholar 

  37. An HS, Bae EJ, Kim GB, Kwon BS, Beak JS, Kim EK, et al. Pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Korean Circ J. 2010;40(3):131–6. Pubmed Central PMCID: 2844979.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Slaughter JL, Pakrashi T, Jones DE, South AP, Shah TA. Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation. J Perinatol. 2011;31(10):635–40.

    Article  CAS  PubMed  Google Scholar 

  39. Bhat R, Salas AA, Foster C, Carlo WA, Ambalavanan N. Prospective analysis of pulmonary hypertension in extremely low birth weight infants. Pediatrics. 2012;129(3):e682–9. Pubmed Central PMCID: 3289526.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kumar VH, Hutchison AA, Lakshminrusimha S, Morin 3rd FC, Wynn RJ, Ryan RM. Characteristics of pulmonary hypertension in preterm neonates. J Perinatol. 2007;27(4):214–9.

    Article  CAS  PubMed  Google Scholar 

  41. Sharma PB, Baroody F, Gozal D, Lester LA. Obstructive sleep apnea in the formerly preterm infant: an overlooked diagnosis. Front Neurol. 2011;2:73. Pubmed Central PMCID: 3226060.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Graham RJ, Fleegler EW, Robinson WM. Chronic ventilator need in the community: a 2005 pediatric census of Massachusetts. Pediatrics. 2007;119(6):e1280–7.

    Article  PubMed  Google Scholar 

  43. Sakashita K, Matthews WJ, Yamamoto LG. Disaster preparedness for technology and electricity-dependent children and youth with special health care needs. Clin Pediatr. 2013;52(6):549–56.

    Article  Google Scholar 

  44. Kun SS, Davidson-Ward SL, Hulse LM, Keens TG. How much do primary care givers know about tracheostomy and home ventilator emergency care? Pediatr Pulmonol. 2010;45(3):270–4.

    PubMed  Google Scholar 

  45. Kun SS, Edwards JD, Ward SL, Keens TG. Hospital readmissions for newly discharged pediatric home mechanical ventilation patients. Pediatr Pulmonol. 2012;47(4):409–14. Pubmed Central PMCID: 3694986.

    Article  PubMed  Google Scholar 

  46. Panitch HB. Viral respiratory infections in children with technology dependence and neuromuscular disorders. Pediatr Infect Dis J. 2004;23(11 Suppl):S222–7.

    Article  PubMed  Google Scholar 

  47. Chidekel AS, Rosen CL, Bazzy AR. Rhinovirus infection associated with serious lower respiratory illness in patients with bronchopulmonary dysplasia. Pediatr Infect Dis J. 1997;16(1):43–7.

    Article  CAS  PubMed  Google Scholar 

  48. American Academy of Pediatrics Committee on Infectious Diseases, American Academy of Pediatrics Bronchiolitis Guidelines C. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics. 2014;134(2):415–20.

    Article  Google Scholar 

  49. Hsu KK, Shea KM, Stevenson AE, Pelton SI, Members of the Massachusetts Department of Public H. Underlying conditions in children with invasive pneumococcal disease in the conjugate vaccine era. Pediatr Infect Dis J. 2011;30(3):251–3.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, 200 N. Wolfe St., David M. Rubenstein Building, Baltimore, MD, 21287, USA

    Sharon A. McGrath-Morrow M.D., M.B.A. & J. Michael Collaco M.D., M.P.H.

Authors
  1. Sharon A. McGrath-Morrow M.D., M.B.A.
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  2. J. Michael Collaco M.D., M.P.H.
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Corresponding author

Correspondence to J. Michael Collaco M.D., M.P.H. .

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Editors and Affiliations

  1. Eudowood Division of Pediatric Respiratory Sciences, The Johns Hopkins University School of Medicine, BALTIMORE, Maryland, USA

    Laura M. Sterni

  2. Division of Pediatric Pulmonary and Sleep Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

    John L. Carroll

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McGrath-Morrow, S.A., Collaco, J.M. (2016). Long-Term Ventilator Support in Bronchopulmonary Dysplasia. In: Sterni, L., Carroll, J. (eds) Caring for the Ventilator Dependent Child. Respiratory Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-3749-3_15

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  • DOI: https://doi.org/10.1007/978-1-4939-3749-3_15

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  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-3747-9

  • Online ISBN: 978-1-4939-3749-3

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