Use and outcomes of long-term noninvasive ventilation for infants

Abstract

OBJECTIVE: The aim of this study is to compare the clinical characteristics, technology and outcomes between infants and older children using long-term NIV. METHODS: In this 10-year retrospective review, 120 infants were matched to 240 older children in a 1:2 ratio based on sex and closest date of NIV initiation. Medical charts and sleep laboratory records were reviewed to extract demographic, NIV technology, polysomnography and clinic outcome data. RESULTS: The results demonstrate a greater proportion of cardiorespiratory disease [16% vs. 6%, OR 3.04 (95% CI 1.47 to 6.31)] and a lower proportion of upper airway disorders [46% vs. 60%, OR 0.56 (95% CI 0.36 to 0.87)] in infants compared to older children. Infants had more comorbidities [4.0 (IQR 3.0) vs. 3.0 (IQR 2.0), p < 0.001] and used more additional technology [36% vs. 16%, OR 2.88 (1.73 to 4.78)] than older children. Improvements in respiratory parameters and NIV adherence were similar between groups. While NIV clinic discharge rates were similar, the reason for discharge differed with infants primarily ceasing NIV due to improvements in the underlying disease condition [42% vs. 30%, OR 2.04 (1.04 to 4.03)] or switching to invasive mechanical ventilation [10% vs. 1%, OR 11.43 (1.34 to 97.47)] while older children transferred to other services [9% vs. 35%, OR 0.17 (0.06 to 0.46)]. CONCLUSIONS: These results suggest infants are a distinct group with respect to NIV therapy and support the need for modifications in the approach to long-term NIV use in infants.