The Use and Outcomes of Long-term Non-invasive Ventilation in Infants

• Author / Creator

  Bedi, Prabhjot K

• Background: The use of long-term non-invasive ventilation (NIV), defined as the provision of respiratory support from the upper airway through a mask interface, has increased in infants and older children over the past two decades. A number of studies have been published on NIV use in the overall pediatric population, but there appears to be fewer studies exclusively on the infant population. This finding suggests that the treatment approach to NIV therapy is similar between infants and older children. However, differences in the underlying disorders necessitating NIV, along with differences in sleep and breathing across infancy and childhood suggest that a distinct treatment strategy for these two groups may be appropriate. The aims of this thesis are: (1) to perform a comprehensive review of the literature to establish the data currently available on the use of long-term NIV in infants; and to compare (2) baseline clinical characteristics, (3) technology use, and (4) outcomes of infants and older children on long-term NIV, to determine if infants represent a distinct group with respect to NIV therapy compared to older children. Methods: Aim (1): A systematic review of the literature on the use of long-term NIV in infants was conducted. Articles were searched for in Ovid Medline, Ovid Embase, CINAHL (via EbscoHOST), PubMed, and Wiley Cochrane Library. The inclusion criteria was studies presenting distinct data on infants (0 to ≤2 years) using long-term NIV (> 3 months of use) outside an acute care setting. Aims (2,3, and 4): A 10-year retrospective chart review of all children using long-term NIV at two pediatric NIV clinics in Alberta, Canada was also performed. Medical charts and sleep laboratory records were reviewed, and demographic, clinical characteristic and health outcome data were extracted. Infants were matched to older children in a 1:2 ratio with respect to sex and the date of NIV start. Results: Aim (1): A total of 52 studies on infants using long-term NIV were included and analyzed in the systematic review. There were studies on a diverse group of upper airway conditions such as obstructive sleep apnea, laryngo-tracheomalacia, and Pierre Robin sequence. However, studies on neuromuscular and central nervous system disorders looked almost exclusively at spinal muscular atrophy type 1 and central hypoventilation syndrome respectively. While studies on upper airway disorders presented changes in respiratory parameters and discontinuation outcomes, studies on neuromuscular disease reported on hospitalizations and survival outcomes. Aims (2, 3, and 4): Data for the retrospective review were collected for 622 children, of which 122 (20%) were infants. After matching, 120 infants were paired with 240 older children. There were some similarities between infants and older children, including improvements in respiratory parameters and adherence rates. Differences between the two groups included the underlying condition necessitating NIV, with older children having more upper airway disorders and infants having more cardiopulmonary disease. Infants had more co-morbidities and required more additional technology compared to older children. Reasons for clinic discharge also differed between groups, with infants discharging because of either improvements in the underlying condition or switch to invasive ventilation, while older children were transferred to adult services. Conclusions: Overall, NIV appears to be a viable method of providing long-term breathing support in infants. Differences in baseline clinical characteristics, sleep and respiratory parameters, technology use, and outcomes such as reasons for clinic discharge were different between infants and older children, supporting the idea that infants represent a distinct population within the overall pediatric NIV population.

• Subjects / Keywords

  • Child
  • Outcome
  • Pediatrics
  • Non-invasive
  • Long-term
  • Ventilation
  • Infants

• Graduation date

  Fall 2017

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/R3XS5JX0S

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.