MANAGEMENT OF SEQUELAE OF BRONCHOPULMONAR Y DYSPLASIA IN A FOLLOW-UP CARE NURSERY

Infants born before 31 weeks of gestation have an increased chance of survival with modern neonatal intensive care methods but are at high r isk for bronchopulmonary dysplasia (BPD), a multifactorial condition d efined as a need for oxygen therapy beyond the 28th postnatal day and classified as severe if it requires mechanical ventilation. A descript ion is given of the management in a follow-up care nursery of five boy s and one girl with severe BPD requiring tracheotomy and assisted vent ilation. Mean birth weight was 1220 g (range, 900-1550 g), mean gestat ional age was 29 weeks (26-31 weeks), and the mean number of days spen t in the hospital at referral to the follow-up care nursery was 388 (r ange, 220-570). Numerous mechanical and infectious complications occur red. Three children were eventually discharged to their home after bei ng successfully weaned from the ventilator. Another patient requires f our sessions of nocturnal assisted ventilation per week, but spends we ekends at home where the appropriate equipment is available. The two r emaining patients are still in the nursery; one has been weaned from t he ventilator, and the other requires continuous ventilatory assistanc e. Follow-up care nurseries provide infants with both the highly techn ical care they need and a relatively normal lifestyle. Although the in cidence of BPD can be expected to decrease as progress is made in the prevention of severe prematurity and neonatal respiratory distress syn dromes, severe cases will continue to occur. An effective and cost-sav ing approach to the management of such cases is close collaboration be tween hospitals and institutions such as that underlying our follow-up care nursery.