Inpatient Clinical Pathway for the Post-N/IICU Management of Infants with Severe Bronchopulmonary Dysplasia (BPD)
Review Criteria for Transfer from N/IICU - High flow nasal cannula flow of ≤ 4 LPM and ≤ 40% FiO2 for at least 24 hr with stable respiratory status and appropriate growth
- No significant bradycardia/desaturation events requiring intervention
- Pulmonary hypertension stable on enteral meds
- No imminent neurosurgical interventions planned
- Limited changes to the care plan for 24-48 hr prior to expected transfer
- Consult
- Pulmonary BPD Team
- Complex Care Blue Team
- Prepare family for transfer; consider family transition meeting
- Initiate bed request for Complex Care Blue when bed available
- N/IICU hand-off to Complex Care
Transfer to Complex Care Blue Team
Assess Readiness to Wean Weekly - Review:
- Trends in O2 saturations, FiO2 needs, RR, resting HR
- All growth parameters
- Ability to tolerate and progress with therapies
- Recommendations from BPD team
- Review:
- Allow patient to adjust to weaning of respiratory support; avoid changing feeding regimen for 1-2 days following wean
- Feeding Schedule
- GERD
- Oral Stimulation and Feeding
- Enteral Tube Considerations
Wean Respiratory Support When Clinically Appropriate
Failure to Wean - Return to previously tolerated level of support
- Consider differential diagnosis
- Review with Pulmonary BPD Team
- Reattempt wean when stable
Step | LPM | |
---|---|---|
1 | 4 | HFNC with Blended O2 |
2 | 3 | |
3 | 2 | FiO2 100% Delivery via NC from oxygen source provides lower effective FiO2 than 100% |
4 | 1 | |
5 | 0.5 | |
6 | RA | 0.25 LPM (FiO2 100%) may be an intermediate step prior to RA depending on patient condition and discussion with BPD team |
Successful Wean to Discharge Level of Respiratory Support
RA preferred; may consider ≤ 0.5 LPM in discussion with BPD team
RA preferred; may consider ≤ 0.5 LPM in discussion with BPD team
- Monitor tolerance
- Observe patient for minimum of 3 days
Posted: April 2022
Revised: May 2022
Authors: M. Dunn, MD; P. Mazzeo MD; K. Gibbs, MD; K. Mckenna, MD; A. Hogan, MD; D. Tauber, MD; J. Fierro, MD; J. Welc, SLP; K. Nilan, RN; C. Ehritz, RN; E. Becker, RN; L. Soorikian, RT
Revised: May 2022
Authors: M. Dunn, MD; P. Mazzeo MD; K. Gibbs, MD; K. Mckenna, MD; A. Hogan, MD; D. Tauber, MD; J. Fierro, MD; J. Welc, SLP; K. Nilan, RN; C. Ehritz, RN; E. Becker, RN; L. Soorikian, RT
Evidence
- The Clinical Evaluation of Severe Bronchopulmonary Dysplasia
- The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach
- Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia
- Pulmonary Hypertension Associated with Bronchopulmonary Dysplasia: A Review
- State of the Science. Feeding Readiness in the Preterm Infant
- Non-nutritive Sucking for Increasing Physiologic Stability and Nutrition in Preterm Infants
- Oxygen Delivery Through Nasal Cannulae to Preterm Infants: Can Practice Be Improved?