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Predicting death or tracheostomy placement in infants with severe bronchopulmonary dysplasia

Journal of Perinatology volume 34, pages 543–548 (2014)Cite this article

Subjects

Abstract

Objective:

To estimate the risk of death or tracheostomy placement (D/T) in infants with severe bronchopulmonary dysplasia (sBPD) born <32 weeks' gestation referred to regional neonatal intensive care units.

Study Design:

We conducted a retrospective cohort study in infants born <32 weeks’ gestation with sBPD in 2010–2011, using the Children's Hospital Neonatal Database. sBPD was defined as the need for FiO2 ⩾0.3, nasal cannula support >2 l min−1 or positive pressure at 36 weeks' post menstrual age. The primary outcome was D/T before discharge. Predictors associated with D/T in bivariable analyses (P<0.2) were used to develop a multivariable logistic regression equation using 80% of the cohort. This equation was validated in the remaining 20% of infants.

Result:

Of 793 eligible patients, the mean gestational age was 26 weeks' and the median age at referral was 6.4 weeks. D/T occurred in 20% of infants. Multivariable analysis showed that later gestational age at birth, later age at referral along with pulmonary management as the primary reason for referal, mechanical ventilation at the time of referral, clinically diagnosed pulmonary hypertension, systemic corticosteroids after referral and occurrence of a bloodstream infection after referral were each associated with D/T. The model performed well with validation (area under curve 0.86, goodness-of-fit χ2, P=0.66).

Conclusion:

Seven clinical variables predicted D/T in this large, contemporary cohort with sBPD. These results can be used to inform clinicians who counsel families of affected infants and to assist in the design of future prospective trials.

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Acknowledgements

JMA, DJD, FDD, JRE (Chair), KM, MAP, EKP, KMR and BLS are members of the Children’s Hospital Neonatal Consortium, Inc. The CHNC (http://www.thechnc.org) has partnered with Children’s Hospital Association, Inc. (Overland Park, KS, USA) to design, launch and maintain the CHND. We are indebted to the following institutions that serve the infants and their families, and these institutions also have invested in and continue to participate in the Children’s Hospital’s Neonatal Database (CHND). For more information please contact Kate Conrad (chnd@childrenshospitals.org). The site sponsors for the CHND are also included:

1 Children's Healthcare of Atlanta, Atlanta, GA (Francine Dykes, Anthony Piazza)

2 Children’s Healthcare of Atlanta at Scottish Rite (Gregory Sysyn)

3 Children's Hospital of Alabama, Birmingham, AL (Carl Coghill)

4 Le Bonheur Children's Hospital, Memphis, TN (Ramasubbareddy Dhanireddy)

5 Children's Hospital Boston, Boston, MA (Anne Hansen)

6 Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL (Karna Murthy)

7 Nationwide Children's Hospital, Columbus, OH (Kristina Reber)

8 Children's Medical Center, Dallas, TX (Rashmin Savani, Luc Brion)

9 Children's Hospital Colorado, Aurora, CO (Theresa Grover)

10 Children’s Hospital of Michigan, Detroit, MI (Girija Natarajan)

11 Cook Children's Health Care System, Fort Worth, TX (Jonathan Nedrelow, Annie Chi)

12 Texas Children's Hospital, Houston, TX (Yvette Johnson)

13 Children's Mercy Hospitals & Clinics, Kansas City, MO (Eugenia Pallotto)

14 Arkansas Children's Hospital, Little Rock, AR (Becky Rodgers)

15 Children’s Hospital Los Angeles, Los Angeles, CA (Lisa Kelly*, Steven Chin)

16 Children's Hospital & Research Center Oakland, Oakland, CA (David Durand, Jeanette Asselin)

17 The Children's Hospital of Philadelphia, Philadelphia, PA (Jacquelyn Evans, Michael Padula)

18 Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Beverly Brozanski)

19 St Louis Children's Hospital, St Louis, MO (Joan Rosenbaum, Tasmin Najaf, Rakesh Rao, Amit Mathur)

20 All Children's Hospital, St. Petersburg, FL (Victor McKay)

21 Rady Children's Hospital, San Diego, CA (Mark Speziale)

22 Children's National Medical Center, Washington, DC (Billie Short)

23 AI DuPont Hospital for Children, Wilmington, DE (Kevin Sullivan)

24 Primary Children’s Medical Center, Salt Lake City, UT (Donald Null)

25 Children’s Hospital of Wisconsin, Milwaukee, WI (Michael Uhing)

26 Children’s Hospital of Omaha (Lynne Willett, John Grebe)

27 Florida Hospital for Children (Rajan Wadhawan)

*deceased

Author information

Author notes

  1. K Murthy, J M Asselin, D J Durand, B L Short, E K Pallotto, M A Padula, F D Dykes, K M Reber and J R Evans: Form the Children’s Hospitals Neonatal Consortium (CHNC).

Authors and Affiliations

  1. Department of Pediatrics, Feinberg School of Medicine, Northwestern University and the Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    K Murthy

  2. Department of Pediatrics, University of Texas Southwestern Medical Center and the Children’s Medical Center of Dallas, Dallas, TX, USA

    R C Savani

  3. Department of Pediatrics, Medical College of Wisconsin and the Children’s Hospital of Wisconsin, Milwaukee, WI, USA,

    J M Lagatta

  4. Department of Analytics, Children’s Hospital Association, Overland Park, KS, USA,

    I Zaniletti

  5. Department of Pediatrics, University of Central Florida and the Florida Hospital for Children, Orlando, FL, USA

    R Wadhawan

  6. Department of Pediatrics, University of Missouri-Kansas City School of Medicine and the Children’s Mercy Hospitals & Clinics, Kansas, MO, USA

    W Truog & E K Pallotto

  7. University of Colorado School of Medicine and the Colorado Children’s Hospital, Aurora, CO, USA,

    T R Grover

  8. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    H Zhang, M A Padula & J R Evans

  9. Department of Pediatrics, Children’s Hospital Oakland & Research Center, Oakland, CA, USA

    J M Asselin & D J Durand

  10. Department of Pediatrics, George Washington University School of Medicine and Children’s National Medical Center, Washington, DC, USA,

    B L Short

  11. Department of Pediatrics, Emory University School of Medicine and the Children’s Healthcare of Atlanta at Egleston, Atlanta, GA, USA

    F D Dykes

  12. Department of Pediatrics and Center for Perinatal Research, The Ohio State University College of Medicine and the Nationwide Children’s Hospital, Columbus, OH, USA

    K M Reber

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  1. K Murthy
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Corresponding author

Correspondence to K Murthy.

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Competing interests

A portion of JMA’s salary was provided by Children’s Hospital Association, Inc., for the development and maintenance of the database that was analyzed for this study. Remaining authors have no conflicts of interest relevant to this article to disclose. Also, the Friends of Prentice Foundation, USA (Chicago, IL) sponsored a portion of this work. Dr RCS receives salary support from the William Buchanan Chair in Pediatrics within his affiliated institution. The sponsors had no input in the study design, the collection, analysis and interpretation of data, the writing of the report and the decision to submit the paper for publication.

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Murthy, K., Savani, R., Lagatta, J. et al. Predicting death or tracheostomy placement in infants with severe bronchopulmonary dysplasia. J Perinatol 34, 543–548 (2014). https://doi.org/10.1038/jp.2014.35

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