TOPLINE

Among premature infants with bronchopulmonary dysplasia (BPD) who required home respiratory support, the use of noninvasive positive airway pressure (NI-PAP) increased over time while tracheostomy use declined; compared with tracheostomy, NI-PAP was associated with earlier hospital discharge and discontinuation of respiratory support and fewer hospital readmissions.

METHODOLOGY

• Researchers conducted a retrospective cohort study to compare clinical outcomes among premature infants with moderate-to-severe BPD who were discharged on supplemental oxygen, NI‐PAP, or tracheostomy ventilation.
• They included 102 infants (65.7% boys) born before 32 weeks’ gestation between 2013 and 2022 who were discharged from level III or IV NICUs in British Columbia.
• The infants were grouped by the type of home respiratory support provided: those receiving supplemental oxygen via nasal cannula (n = 53), those receiving NI-PAP (continuous or bilevel; n = 40), and those receiving tracheostomy ventilation (n = 9).
• Data on patient characteristics, healthcare use, and duration of home respiratory support were obtained from electronic medical records and clinical databases.
• Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition, producing cognitive, language, and motor composite scores; a composite score < 85 was considered below the expected range.

TAKEAWAY

• The use of home NI-PAP increased from 26% of discharges during 2013-2017 to 46% of discharges during 2018-2022, whereas the use of tracheostomy declined from 14% to 6%.
• Infants discharged on tracheostomy ventilation were older at hospital discharge than those on NI-PAP or supplemental oxygen (median age, 386 days vs 213 days vs 136 days; P < .001). Infants discharged on tracheostomy ventilation also discontinued respiratory support later than infants on NI‑PAP (median age at time of discontinuation, 4.2 years vs 1.4 years; P < .001).
• Readmissions within 2 years for acute respiratory issues were more frequent after discharge on tracheostomy ventilation than after discharge on NI-PAP or supplemental oxygen (90% vs 51% vs 43%; P = .042).
• An adjusted analysis showed that infants discharged on tracheostomy ventilation had lower cognitive and motor composite scores at 8 and 18 months of age than those discharged on NI‑PAP; the authors attributed this gap to greater disease severity in the tracheostomy group, not to the ventilation method itself.

IN PRACTICE

“Although these findings likely reflect differences in underlying disease severity and clinical complexity, they suggest that NI-PAP may provide an effective alternative to tracheostomy ventilation for appropriately selected infants with moderate-to-severe BPD,” the authors of the study wrote.

SOURCE

The study was led by Kudrat Mundi, University of British Columbia, Vancouver, Canada. It was published online on July 4, 2026, in Pediatric Pulmonology.

LIMITATIONS

As a retrospective observational study, there was a potential for missing data, and incomplete neurodevelopmental assessments may have been more common among children with greater impairment. The tracheostomy group was small. Moreover, tracheostomy was performed later in this cohort than at other centers, which may have limited the generalizability of the findings.

DISCLOSURES

The study was supported by the University of British Columbia Faculty of Medicine Summer Student Research Program. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.