274 - Respiratory Status at 36 Weeks Corrected Gestational Age as a Marker for Tracheostomy in Very Low Birth weight infants with Severe Bronchopulmonary Dysplasia.

Severe bronchopulmonary dysplasia (sBPD) remains a leading cause of late morbidity and mortality in extremely preterm infants. The most affected of these patients require a tracheostomy and home mechanical ventilation (TR+HMV). Better understanding of the risk factors leading to tracheostomy (TR) may improve early recognition of infants at highest risk and lead to identification of early modifiable factors.  

Objective:

To define the clinical characteristics from birth to 36 weeks corrected gestational age (CGA) of infants admitted in a level 4 neonatal intensive care unit at Atrium Health Wake Forest , from 2016-2021 with the diagnosis of sBPD who required TR+HMV versus those who did not (NTR).

Design/Methods:

We collected demographic, prenatal, and postnatal data via retrospective chart review of very low birth weight infants with a gestational age < 30 weeks, inborn or transferred to our unit, prior to 36 weeks CGA (Table 1). sBPD was defined as need for CPAP, non-invasive or invasive mechanical ventilation at 36 weeks CGA. Descriptive statistics compared sBPD infants requiring TR with those NTR. The three most highly significant variables on univariate analysis were included in logistic regression modeling to associate with the need for TR. Statistical significance was set at p< 0.05.

Results:

During the epoch, 53 infants with sBPD were identified, 17 which required TR prior to discharge.  Univariate analysis revealed significant differences in birthweight, pulmonary hypertension at 36 weeks CGA, Respiratory severity score (RSS) at 36 weeks CGA, and invasive mechanical ventilation at 36 weeks (Table 1). Logistic regression found invasive mechanical ventilation at 36 weeks CGA (OR 7.43; 95% CI: 1.4-39.4, p=0.019) was significantly associated with the need for TR. By 39 weeks CGA at least 80% of intubated infants will ultimately require TR (Graph 1). Even at 44 weeks CGA, 2 intubated infants avoided a TR. The median age at TR was 47 weeks CGA (interquartile range 46-50 weeks).

Conclusion(s):

In this retrospective cohort study, the need for mechanical ventilation was a significant marker of TR+HMV.  Early factors such as chorioamnionitis, prolonged rupture of membranes, and SGA status and any infection did not impact the ultimate need for TR+HMV. Larger studies are needed to confirm these findings and to better identify modifiable risk factors in infants at risk of TR.