Reframing Risk: Intubation Time Outweighs Tracheostomy in Predicting Neurodevelopment in Severe BPD.

Abstract

Bronchopulmonary dysplasia (BPD) is a chronic lung disease of prematurity that often requires prolonged respiratory support, including intubation and tracheostomy. While these interventions are essential for stability, their impact on neurodevelopmental outcomes remains unclear. This study evaluates whether tracheostomy is independently associated with neurodevelopmental outcomes in patients with severe BPD. This retrospective cohort study included infants who met the 2001 NIH criteria for severe BPD, with or without tracheostomy, treated at a quaternary-care children's hospital from 2011 to 2023. Demographics, clinical factors, intubation duration, and Bayley neurodevelopmental scores (12-24 months corrected age) were collected. Tracheostomy-dependent patients were case-matched 1:2 to non-tracheostomy-dependent BPD patients by gestational age and sex. Associations with Bayley scores were analyzed using univariate and multivariate linear regression with cluster-robust standard errors. Twenty-five tracheostomy-dependent BPD patients were matched to 50 non-tracheostomy-dependent BPD patients. Tracheostomy-dependent patients had significantly longer intubation durations (114 vs. 66 days, p = 0.0047). In adjusted models accounting for tracheostomy status and relevant neurologic comorbidities, patients intubated longer than 50 days had significantly lower Bayley cognitive (-8.49 points, p = 0.047) and motor scores (-11.03 points, p = 0.012), suggesting a notable developmental difference. Tracheostomy status was not independently associated with cognitive (p = 0.697) or motor (p = 0.715) outcomes. Our findings suggest that prolonged intubation is associated with worse neurocognitive and motor outcomes in infants with BPD, whereas tracheostomy placement was not an independent predictor of neurodevelopmental delays. Prospective studies are needed to determine whether early tracheostomy, aimed at reducing total days intubated, may improve long-term outcomes.