Retrospective cohort study of 102 preterm infants (<32 weeks' gestation) discharged from Level III–IV NICUs in British Columbia (2013–2022) on supplemental oxygen, home NI-PAP (CPAP or BPAP), or tracheostomy ventilation (TV) for BPD; compared healthcare utilization, growth, and neurodevelopmental outcomes across groups using adjusted linear mixed-effects models.
NI-PAP use rose from 26% to 46% of discharges across the two 5-year periods, while tracheostomy use fell from 14% to 6%. NI-PAP infants were discharged earlier (median 213 days vs. 386 days for TV, p<0.001), discontinued respiratory support younger (median 1.4 vs. 4.2 years, p<0.001), and had fewer respiratory readmissions within 2 years (51% vs. 90%). TV infants had lower BSID-III motor and cognitive scores at 8 and 18 months, with median motor composites below normal (58 at 8 months; 52 at 18 months). Growth trajectories were similar, with a statistically significant weight-for-age z-score difference only at 4.5 years (adjusted mean difference: −1.33, 95% CI: −2.56 to −0.10).
- Small tracheostomy group (n=9) limits statistical power and precludes propensity-score or causal-inference methods. - Retrospective design with confounding by indication — TV infants had more severe disease (89% vs. 40% pulmonary hypertension), making outcome differences difficult to attribute to ventilation modality. - Later tracheostomy timing (median 57 weeks PMA) vs. other centers may limit generalizability to programs that place tracheostomies earlier.
For preterm infants with moderate-to-severe BPD who can tolerate ≥4 hours off positive pressure and maintain gas exchange via nasal interface, home NI-PAP is a feasible first-line alternative to tracheostomy — associated with shorter hospitalization and fewer readmissions. Pulmonary hypertension requiring treatment and ongoing invasive ventilation at 40 weeks PMA are key flags that predict eventual tracheostomy need and should prompt early, multidisciplinary decision-making.
Explore related topics
