Introduction
Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease
of prematurity with an estimated 10,000 to 15,000 infants diagnosed with
BPD annually in the United States. Despite changes in diagnostic
criteria, most studies suggest that both the incidence and prevalence
have remained stable.1,2 Patients diagnosed with BPD
necessitate increased healthcare resources and often require long-term
respiratory support. Additionally, comorbid medical conditions such as
pulmonary hypertension and other sequelae of prematurity can influence
their need for further care.3-9
Tracheostomy placement is often considered for children with
BPD.10,11 These patients require prolonged
hospitalization and long-term intensive care given their medical
complexity.12-16 Research on tracheostomy outcomes for
children with BPD has yielded varied findings on morbidity and
mortality, perhaps due to the influence of
comorbidities.17-20 The relationship between patient
characteristics, rates of tracheostomy, hospital readmissions, and
mortality have been described for children with
BPD.21,22 The increasing use of tracheostomy in this
population has resulted in single-instution series on duration of
ventilator support and tracheostomy
dependence.17,18,20,23 However, there have been
limited prospective studies looking at long-term ventilator and
tracheostomy outcomes among children with BPD.
The Children’s Health Airway Management Program (CHAMP) prospectively
follows all children who had tracheostomy placement at Children’s
Medical Center Dallas. Children are enrolled in a registry until
decannulation, death, or reaching 21 years of age. This dataset has been
used previously to publish work related to perioperative outcomes,
socioeconomic and racial disparities, as well as tracheostomy caregiver
quality of life.24-27 CHAMP is therefore well-suited
to explore longterm outcomes after tracheostomy surgery in children with
BPD. The primary objective of this study is to examine the relationship
between the presence of BPD and pulmonary hypertension with a patient’s
time to ventilator liberation as well as eventual decannulation. Based
on prior data,28 we hypothesized that children
diagnosed with BPD and resultant secondary pulmonary hypertension would
have an increased duration of mechanical ventilation and thus a
prolonged time to tracheostomy decannulation.