Difficult-to-wean bronchopulmonary dysplasia beyond the NICU: management and outcomes in a tertiary respiratory centre

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Background: Bronchopulmonary dysplasia (BPD) is the most common respiratory complication of preterm birth. There is no consensus on evaluation and management of BPD patients who cannot be weaned off respiratory support in the NICU. Aim: To characterise management and outcomes in a cohort of BPD patients needing respiratory support beyond NICU. Methods: Neonatal and respiratory follow-up data were collected for all BPD infants referred to a tertiary respiratory centre (2019 until 2024) for work-up and establishment of chronic respiratory support. Results:40 infants were included, main demographic and respiratory characteristics are shown in Table 1. Work-up consisted of: sleep study (100%), echocardiogram (83%), chest CT (73%), pH/impedance study (58%) and genetic testing (53%). 21 infants had pulmonary hypertension. 14 infants arrived on pressure support, 21 were established on home NIV. One year after establishment, 15 patients were self-ventilating in room air, 2 had a tracheostomy. Duration of neonatal mechanical ventilation was higher in the infants still requiring NIV after one year (p=0.04). Mean TcPCO2 levels decreased across the timepoints. Conclusion: Pressure support allowed wean from HFNC possibly by re-recruiting distal airways. Prolonged neonatal ventilation was associated with higher need for NIV at 1 year. A standardised approach to management of weaning in this population is needed. erj;66/suppl_69/PA2722/F1 F1 F1

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