Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia

J Perinatol. 2017 Jun;37(6):723-727. doi: 10.1038/jp.2016.277. Epub 2017 Feb 9.


Objective: To estimate the presence and sources of inter-center variation (ICV) in the risk of death or tracheostomy placement (D/T) among infants with severe bronchopulmonary dysplasia (sBPD)Study design:We analyzed the Children's Hospitals Neonatal Database between 2010 and 2013 to identify referred infants born <32 weeks' gestation with sBPD. The association between center and the primary outcome of D/T was analyzed by multivariable modeling. Hypothesized diagnoses/practices were included to determine if these explained any observed ICV in D/T.

Results: D/T occurred in 280 (20%) of 1383 eligible infants from 21 centers. ICV was significant for D/T (range 2-46% by center, P<0.001) and tracheostomy placement (n=187, range 2-37%, P<0.001), but not death (n=93, range 0-19%, P=0.08). This association persisted in multivariable analysis (adjusted center-specific odds ratios for D/T varied 5.5-fold, P=0.009).

Conclusions: ICV in D/T is apparent among infants with sBPD. These results highlight that the indications for tracheostomy (and subsequent chronic ventilation) remain uncertain.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bronchopulmonary Dysplasia / mortality*
  • Bronchopulmonary Dysplasia / surgery*
  • Databases, Factual
  • Female
  • Gestational Age
  • Humans
  • Infant
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Intensive Care Units, Neonatal / statistics & numerical data*
  • Male
  • Multivariate Analysis
  • Severity of Illness Index
  • Tracheostomy / statistics & numerical data*
  • United States / epidemiology