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The Prevalence and Outcome of Chronic Lung Disease Babies in a Tertiary Neonatal Unit

The Prevalence and Outcome of Chronic Lung Disease Babies in a Tertiary Neonatal Unit. QUAD NETWORK RESEARCH STUDY DAY Anju Singh Amy Walker Shree Vishna Rasiah. Background. Chronic lung disease

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The Prevalence and Outcome of Chronic Lung Disease Babies in a Tertiary Neonatal Unit

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  1. The Prevalence and Outcome of Chronic Lung DiseaseBabies in a Tertiary Neonatal Unit QUAD NETWORK RESEARCH STUDY DAY Anju Singh Amy Walker Shree VishnaRasiah

  2. Background • Chronic lung disease • major morbidity among preterm babies especially those extremely low birth babies (<1000grams) • prolonged hospital stays • discharge from the hospital with oxygen therapy • frequent readmission to the hospital in the first year of life • risk of neurodevelopmental delays

  3. Chronic lung disease • morbidity and mortality more so in those with evidence of pulmonary hypertension • need for additional ongoing medical support whilst on the neonatal unit and at home

  4. Early CPAP Vs Intubation • SUPPORT NEJM (1316 infants, 24 weeks- 27+6) • VON, 2010(648 infants, 26 – 29 +6) • COIN, NEJM (610 infants, 25-28+6), Morley 2008 • CURPAP Paeds ( 208 infants, 25-28+6), Sandri et al No difference in the primary outcome of Death or BPD

  5. Stevens T.P., Blennow M., Myers E.H. et al. (2007) Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD003063. DOI: 10.1002/14651858. CD003063.pub3 • 6 RCT’s • Lower incidence • mechanical ventilation [typical RR 0.67, 95% CI 0.57, 0.79], • air leak syndromes [typical RR 0.52, 95% CI 0.28, 0.96] • BPD [typical RR 0.51, 95% CI 0.26, 0.99] • Lower treatment threshold (FIO2 < 0.45) reduced incidences of airleak syndromes and BPD • Higher treatment threshold (FIO2 at study > 0.45) was associated with increased risk of PDA

  6. Wheeler K, Klingenberg C, McCallion N, Morley CJ, Davis PG. Volume-targeted versus pressure-limited ventilation in the neonate. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD003666. DOI: 10.1002/14651858.CD003666.pub3 • 12 RCT’s • Use of VTV modes • reduction in the combined outcome of death or bronchopulmonary dysplasia [typical RR 0.73 (95% CI 0.57 to 0.93), NNT8 • Reductions in pneumothorax • days of ventilation • hypocarbia • combined outcome of PVL or grade 3-4 intraventricular haemorrhage

  7. Aims • To understand the prevalence and outcomes of CLD cases in a tertiary neonatal unit 

  8. Methods • Badger database for all cases of CLD (defined by oxygen requirement at 36 weeks corrected gestational age) • Outcomes • Impact on the neonatal services in the last 3 years.

  9. Results • Admissions: 3860 • CLD: 97

  10. Results: demographics

  11. Results: Plurality and Ethinicity

  12. Results: steroids & delivery

  13. Results: Ventilation days

  14. Results: Co-morbidities

  15. Results

  16. Results

  17. Conclusion • Outborns • Less antenatal steroids • More ventilation and CPAP days • More co-morbidities: NEC requiring surgery, ROP requiring laser, significant PDA , grade 3-4 IVH, PVL • More average length of stay • Inborns • More postnatal steroids • More Pulmonary hypertension • More deaths

  18. Implications in practice • Compare time epochs with change in practices • Compare units within regions • Compare national outcomes • Find ways to improve CLD outcomes

  19. Implication for paediatric community services • British Thoracic Society guidelines: • infants with chronic lung disease (CLD) oxygen saturations < 90% : increased risk of ALTE • Saturations below 92% : suboptimal growth • Recommendation: • Oxygen saturations should be maintained at 93% or above • Assess for the suitability of long term oxygen therapy (LTOT) • LE Pritchard. Audit of National Compliance with British Thoracic Society Guidelines for Neonatal Chronic Lung Disease. Arch Dis Child 2012;97:Suppl 1 A28. 65 units • Only 4% units carried out suitability for LTOT • Only 8% units used the BTS target saturations

  20. Conclusion • CLD is a major morbidity among preterm babies • Cases are increasing with increasing survival of extremely preterm babies • Babies with pulmonary hypertension have significantly increased risk of mortality • Implications for community services

  21. Questions?

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