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Risk Factors and Prognosis for Newborns With Chronic Mechanical Ventilation: Preliminary Results of a Retrospective Cohort FREE TO VIEW

Michael Sauthier, MD; Krystale Bergeron-Gallant; Gregory Lodygensky, MD; Guillaume Emeriaud, PhD; Philippe Jouvet, PhD
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CHU Sainte-Justine, Montreal, QC, Canada

Chest. 2015;148(4_MeetingAbstracts):320A. doi:10.1378/chest.2260557
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SESSION TITLE: Mechanical Ventilation Poster Discussion

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Tuesday, October 27, 2015 at 02:45 PM - 04:15 PM

PURPOSE: Prolonged mechanical ventilation (PMV) and chronic mechanical ventilation (CMV) in neonates is associated with a high morbidity and mortality. Risks factors associated with CMV, and prognosis, are unknown. The objective of the study is to identify, among the patients with PMV, those that evolved to CMV, as well as the adverse respiratory, neurological and gastrointestinal sequelae related to ventilation.

METHODS: We conducted a retrospective study of the last 10 years at the CHU Sainte-Justine (Montreal, Canada). Chart review included patients with PMV (≥ 21 days) using the paediatric definition of the 2005 NAMDRC consensus conference (1). Demographic and clinical data, including follow-up at 6, 12 and 18 months corrected age, was collected for each included patient. Risk factors for CMV (≥ 125 days) were determined with univariate analysis, and multivariate analysis with Delphi method will be preformed thereafter. A descriptive analysis is presented in this abstract.

RESULTS: We identified 183 neonates that met criteria for PMV. Patients born between 2004 and 2008 (n=47, 25% of the cohort) were analyzed. Among these 47 newborns, 70% were preterm (n=33) with 14 born before 29 weeks gestation, and 21 had an associated malformation. Of all patients with a malformation (62%, n=29), 13 had a thoracoabdominal anomaly and 11 had congenital heart disease. Twelve patients had CMV with mean ventilation time of 220 days (range 138 - 400 days). 13 patients had pulmonary hypertension. Survival at 18 months corrected age was 71% (25/35) in the PMV group and 75% (9/12) in the CMV group. After consultation of 6 specialists in paediatric and neonatal critical care, 7 risk factors for CMV will be tested in a multivariate analysis and 32 will be tested in a univariate analysis.

CONCLUSIONS: Most newborns in our cohort with PMV have a congenital malformation. Survival at 18 months corrected age appears equivalent in PMV and CMV groups.

CLINICAL IMPLICATIONS: Rapid identification (at 21 days of ventilation) is essential to identify these at-risks neonates of CMV in whom therapeutic alternatives could be considered (new ventilation modes, early treatment of pulmonary hypertension and multidisciplinary development care). (1) Sauthier M, Rose L, P Jouvet. Prolonged mechanical ventilation in children: a proposed definition. Ped Crit Care Med 2015; submitted.

DISCLOSURE: The following authors have nothing to disclose: Michael Sauthier, Krystale Bergeron-Gallant, Gregory Lodygensky, Guillaume Emeriaud, Philippe Jouvet

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