IntroductionBronchopulmonary dysplasia (BPD) is the most common morbidity after premature birth.Severe BPD is defined as a requirement for invasive mechanical ventilation at 36 weeks postmenstrual age, and these infants experience prolonged hospitalizations with frequent care team and provider changes.We hypothesized that a multidisciplinary care team would improve severe BPD clinical outcomes and provide useful input for primary care teams in our quaternary care center.Methods:An inpatient multidisciplinary BPD consultation team was created at Seattle Children's Hospital, including providers from Neonatology, Pulmonology, Pediatric Critical Care, Cardiology, respiratory therapy, nutrition, and occupational/physical therapy.Weekly BPD rounds included primary care teams and reviewed longitudinal information for discussion and documentation of consensus care plans.Two years after our BPD team inception, a provider experience survey was sent to NICU, PICU, Cardiology, and Pulmonary providers.Descriptive statistics include mean +/-standard deviation.Results:Between January 2018 and November 2020, 115 patients were included in BPD rounds, with an average gestational age of 26.8 (+/-4.1 weeks) in 2018, 26.6 (+/-3.5 weeks) in 2019, and 26.4 (+/-2.7 weeks) in 2020.Average birth weights were 880.4g (+/-534g) in 2018, 903.2g (+/-502g) in 2019, and 823.1g (+/-287g) in 2020.At the time of referral to the BPD team, 65.6% of patients in 2018, 57.4% in 2019, and 38.9% in 2020 required invasive mechanical ventilation.34.3% of patients in 2018, 23.4% in 2019, and 22.2% in 2020 required tracheostomy and chronic ventilation.Survival rates for patients followed by the BPD team were 93.8% in 2018, 87.2% in 2019, and 91.2% in 2020.Of the 115 patients, 89 (77.4%) had a significant co-morbidity (NEC, IVH, complex congenital heart disease, or hemodynamically significant PDA).Of 38 BPD provider experience survey responses (14 from NICU, 11 from PICU, 6 from pulmonary, and 7 from cardiology providers), 79% stated that BPD team recommendations were helpful (16% neutral, 5% unhelpful).66% felt the BPD team communication was good (26% neutral, 8% poor).79% felt the BPD team helped the primary team provide better care (13% did not, 8% N/A).Conclusions:We developed a multidisciplinary team to advise on management of severe BPD patients throughout their hospital course.Most providers who care for patients with BPD felt the BPD team was helpful and improved care.Future studies will determine if multidisciplinary BPD rounds improves clinical outcomes such as tracheostomy rates, length of stay, and family experience.

Objective. Current American retinopathy of prematurity (ROP) screening guidelines is imprecise for infants ≥ 30 weeks with birth weights between 1500 and 2000 g. Our objective was to evaluate a risk factor based approach for screening premature infants at low risk for severe ROP. Study Design. We performed a 13-year review from Intermountain Health Care (IHC) data. All neonates born at ≤32 weeks were reviewed to determine ROP screening and/or development of severe ROP. Severe ROP was defined by stage ≥ 3 or need for laser therapy. Regression analysis was used to identify significant risk factors for severe ROP. Results. We identified 4607 neonates ≤ 32 weeks gestation. Following exclusion for death, with no retinal exam or incomplete data, 2791 (61%) were included in the study. Overall, severe ROP occurred in 260 (9.3%), but only 11/1601 ≥ 29 weeks (0.7%). All infants with severe ROP ≥ 29 weeks had at least 2 identified ROP risk factors. Implementation of this risk based screening strategy to the IHC population over the timeline of this study would have eliminated screening in 21% (343/1601) of the screened population. Conclusions. Limiting ROP screening for infants ≥ 29 and ≤ 32 weeks to only those with clinical risk factors could significantly reduce screening exams while identifying all infants with severe ROP.

Objective: Our objective is to assess the frequency of usage, safety and clinical utility of humidified high flow nasal cannula (HHFNC) in two tertiary care hospitals and compare outcomes to a historical control group of premature infants who received nasal continuous positive airway pressure (NCPAP).Study design: The first part of the study describes the increased HHFNC usage in two tertiary neonatal intensive care units. The second part compares outcomes of infants, born at less than 30 weeks gestation, who received either NCPAP or HHFNC as an early respiratory support mode.Results: HHFNC usage increased (64%) after its introduction in infants of all gestational ages whereas the usage of NCPAP decreased from 19 to 4%. Ninety-five percent of infants born at less than 30 weeks gestation received HHFNC at some point during their hospital stay whereas only 12% received NCPAP. There were no differences in death or bronchopulmonary dysplasia (BPD), but ventilator-days per patient were decreased (19.4 to 9.9) following introduction of HHFNC. Comparing the cohort of infants who received either NCPAP or HHFNC as an early mode of respiratory support, there were no differences in deaths, ventilator-days, BPD, blood infections or other outcomes. More infants were intubated for failing early NCPAP compared to early HHFNC ( 40 to 18%).Conclusions: HHFNC was well-tolerated by premature infants. Compared to infants managed with NCPAP, there were no apparent differences in adverse outcomes following the introduction of HHFNC. Additional research is needed to better define the utility and safety of HHFNC compared to NCPAP.

The use of humidified high-flow nasal cannula (HFNC) has expanded greatly in the last several years despite any published trials regarding its safety and/or efficacy in neonates, essentially becoming the treatment of choice over nasal CPAP (NCPAP) in many centers. Objective To describe the prevalence of usage of HFNC vs NCPAP in two large tertiary care hospitals in neonates admitted with respiratory disease. Methods Data were retrospectively reviewed for all NICU admissions from both Wilford Hall MC and Santa Rosa Children's Hospital during the study period. June 2004 was identified as a time point in both centers when the use of HFNC became readily available. Given this, data were collected for those admissions occurring 11 months prior to June 2004 (Era 1) and compared to those admissions occurring 11 months after (Era 2). Subgroup analysis was additionally done for VLBW (defined as < 30 weeks' gestation). This study was independently approved by the IRB of both institutions. Results The use of NCPAP in Era 2 vs Era 1 decreased remarkably from 15% to 2.5% for all NICU admissions and from 39% to 6.7% in VLBW infants. During this same period, the use of HFNC increased from 14% to 61% overall and from 39% to 97% in VLBW infants. In Era 1, there were 566 total admissions and 72 for VLBW infants, compared to 597 and 89 admissions, respectively, for Era 2. Mortality rate (4.0% vs 3.6%) and mean ventilator days (4.0 vs 3.0) overall were similar between the two eras. In VLBW infants, mortality rate decreased from 12.5% to 8.9% and mean ventilator days decreased from 16.2 6 SD to 11.2 6 SD days in Era 1 vs Era 2, respectively. Similar complication rates to include nosocomial infections were found in both eras. Conclusions In our study, the use of HFNC has largely replaced NCPAP for the routine treatment of neonatal respiratory disease and is almost universally used in VLBW infants. HFNC therapy additionally appears to be as efficacious and safe as NCPAP therapy. Further analysis needs to be done to determine whether HFNC improves neonatal outcomes.

We report a case of a premature very low birth weight infant who presented shortly after birth with idiopathic central diabetes insipidus that persisted beyond the neonatal period and has been successfully managed with intranasal 1-desamino-8-D-arginine vasopressin. Although this condition is rare in neonates, early recognition, evaluation, and therapy may prevent more severe morbidity. Long-term successful management resulting in normal growth and development during infancy can be achieved with intranasal 1-desamino-8-D-arginine vasopressin therapy.