THE 10-YEAR EXPERIENCE OF A REFERRAL NEWBORN/INFANT CHRONIC LUNG DISEASE PROGRAM

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ESPR187
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Abstract: :

Background: Bronchopulmonary dysplasia (BPD) is the most common and consequential chronic complication of preterm birth. BPD occurs along a wide-spectrum of severity and management of the most severe forms presents a unique challenge that may be best suited for a multi-disciplinary team-based approach. The Newborn/Infant Chronic Lung Disease Program (NeoCLD) at Children's Hospital of Philadelphia (CHOP) was established in 2010 and has cared for over 500 infants with severe BPD.

Objective: To describe the evolution of our multi-disciplinary care model, patient characteristics, and common therapeutic interventions for infants in our program over 10 years.

Design/Methods: Case series of infants cared for by the NeoCLD program at CHOP from 4/2010 to 11/2019.

Results: 508 infants have been admitted to our program since 2010. Yearly admission numbers and key program milestones are shown in Figure 1. Current program composition and workflow are shown in Figure 2. Consensus care decisions, consistent communication with families, and inter-disciplinary research are program strengths. Patient characteristics are in Table 1. Most patients (65%) were admitted at >36 weeks postmenstrual age (PMA) for CLD care. Those admitted earlier often required care for additional complications of prematurity. In total, 88% of infants survived to hospital discharge and 64% were discharged directly home. Most were treated with systemic corticosteroids, diuretics, and post pyloric feedings. Nearly half were treated for pulmonary hypertension; 33% received sildenafil. Tracheostomy, gastrostomy tube +/- fundoplication were performed in nearly 40%. Markers of illness severity such as admission respiratory severity score and rates of tracheostomy did not change over time. Regional referral patterns are shown in Figure 3.

Conclusion(s): Over a 10-year period, our NeoCLD program grew from a small consult team to a multidisciplinary, inpatient medical service caring for >50 infants with severe CLD per year. Our program model promotes coordinated care and research performed by a diverse group of physicians and surgeons, frontline clinicians family psychologists, nurses, therapists, social workers, case managers, and child-life specialists. Mortality rates among infants in the program were low. However, many infants underwent invasive diagnostics tests and surgical interventions during their hospital stay and were dependent on medical technologies beyond the time of discharge. Large scale studies are needed to optimize care for this vulnerable cohort of patients.


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Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia

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