Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts.
Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts.
Pediatrics. 2023 Aug 1;152(2). doi: 10.1542/peds.2022-061001.
Former premature infants with bronchopulmonary dysplasia (BPD) are at risk for hypoxemia during air travel, but it is unclear until what age. We aimed to determine pass rates for high altitude simulation testing (HAST) by age in children with BPD and identify risks for failure.
Retrospective, observational analysis of HAST in children with BPD at Boston Children's Hospital, using interval censoring to estimate the time-to-event curve of first pass. Curves were stratified by neonatal risk factors. Pass was considered lowest Spo2 ≥ 90%, or ≥94% for subjects with ongoing pulmonary hypertension (PH).
Ninety four HAST studies were analyzed from 63 BPD subjects; 59 studies (63%) were passed. At 3 months corrected gestational age (CGA), 50% of subjects had passed; at 6 months CGA, 67% has passed; at 12 and 18 months CGA, 72% had passed; and at 24 months CGA, 85% had passed. Neonatal factors associated with delayed time-to-pass included postnatal corticosteroid use, respiratory support at NICU discharge, and tracheostomy. BPD infants who did not require respiratory support at 36 weeks were likely to pass (91%) at 6 months CGA. At 24 months, children least likely to pass included those with a history of PH (63%) and those discharged from the NICU with oxygen or respiratory support (71%).
Children with BPD on respiratory support at 36 weeks should be considered for preflight hypoxemia challenges through at least 24 months CGA, and longer if they had PH or went home from NICU on respiratory support.
患有支气管肺发育不良（BPD）的前早产儿在航空旅行中存在低氧血症的风险，但尚不清楚这种风险会持续到什么年龄。我们旨在确定 BPD 患儿进行高空模拟测试（HAST）的通过年龄，并确定失败的风险因素。
回顾性观察性分析波士顿儿童医院 BPD 患儿的 HAST，使用区间 censoring 估计首次通过的时间事件曲线。曲线按新生儿危险因素分层。通过定义为最低 Spo2≥90%，或持续肺动脉高压（PH）的患者为≥94%来判断通过。
从 63 例 BPD 患者中分析了 94 项 HAST 研究；59 项研究（63%）通过。在矫正胎龄（CGA）3 个月时，50%的患者通过；在 6 个月 CGA 时，67%的患者通过；在 12 和 18 个月 CGA 时，72%的患者通过；在 24 个月 CGA 时，85%的患者通过。与通过时间延迟相关的新生儿因素包括出生后皮质类固醇的使用、新生儿重症监护病房（NICU）出院时的呼吸支持和气管切开术。在 36 周时不需要呼吸支持的 BPD 婴儿，在 6 个月 CGA 时很可能通过（91%）。在 24 个月时，最不可能通过的是有 PH 病史的儿童（63%）和从 NICU 出院时需要吸氧或呼吸支持的儿童（71%）。
在 36 周时需要呼吸支持的 BPD 儿童应至少在 24 个月 CGA 时考虑进行飞行前低氧血症挑战，如果有 PH 或从 NICU 出院时需要呼吸支持，则需要更长时间。
