TOP 27 - Outcomes associated with the use of a diagnostic criteria for treating lower respiratory tract infections in infants with severe bronchopulmonary dysplasia and an artificial airway

Publication Number: 1787.TOP 27

Kenna N. Leethy, Phoenix Children's Hospital, Scottsdale, AZ, United States; Savannah Korte, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States; Pamela Griffiths, Phoenix Children's Hospital, Gilbert, AZ, United States; Rhonda Kurz, Phoenix Children's Hospital, Phoenix, AZ, United States; James Woodward, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Preterm infants with severe BPD (sBPD)are at risk for multiple infections that affect long-term lung health. In those with an artificial airway, it is routine to develop bacterial colonization of the airway; however, there are various philosophies on when and if to treat positive bacterial cultures. Inadequate treatment of lower respiratory tract infections (LRTI) may cause harm to infants by promoting ongoing lung inflammation, whereas excess treatment may lead to alterations in the microbiome, increased antimicrobial resistance, and unnecessary lab draws, and venous access. Improved understanding of the factors influencing decisions to evaluate and treat LRTI will inform future guidelines and care practices.

Objective: The aims of this study are to 1) describe assessment and treatment of LRTI in our sBPD cohort, 2) determine how this differs from published guidelines, and 3) evaluate the relationship with outcomes based on guideline compliance. We hypothesize that infants receive antibiotic treatment more often than recommended by criteria and are associated with adverse in-hospital outcomes.

Design/Methods: Infants with Grades 2 and 3 BPD admitted to the NICU between 1/1/2015 and 6/30/2024 who had either an endotracheal tube (ETT) or tracheostomy in place during the NICU stay were included.

Data collection included patient demographics, occurrences and results of respiratory cultures, LRTI treatment and duration, and clinical characteristics including respiratory severity score, tracheostomy, and discharge respiratory support and medications. 176 infants with severe BPD were screened, and 116 infants had at least one respiratory culture performed for a total of 352 respiratory cultures. Median number of cultures per individual was 2 (1, 4) and median number of culture per length of stay (LOS) was 0.02 (0.013, 0.029). 30 subjects have data collected regarding treatment for LRTI. Of 30 infants, 19 (63%) were treated with at least one course of antibiotics and averaged 2.7 treatment courses per patient for a total of 32 courses.

We estimated that 50% of subjects would be treated for an LRTI, providing adequate sample size to detect medium and large effect sizes (Cohen’s D > 0.58, rate differences > 0.29). This estimate is exceeded for the 30 subjects with complete treatment data. Data collection is ongoing and statistical analysis will be completed by January 31st, 2026.