Non-invasive ventilatory support in children with complex neural disability

Abstract

Introduction/Aim: Sleep disordered breathing (SDB) is a major cause of morbidity and mortality among paediatric patients with severe neurological disabilities such as cerebral palsy. Despite increasing use of non-invasive ventilation (NIV) in this group, there remains a lack of consensus about its role and indications. We aim to explore the indications and outcomes of a cohort of children with severe, complex neurological disability and SDB, managed with NIV. Methods: Data was extracted from the electronic medical records of 14 children with severe, complex neurological disabilities (GMFCS V equivalent) initiated on NIV in Queensland over a 5-year period. Demographic, clinical, hospitalization, and polysomnography data was collected, as well as caregiver-reported side effects and NIV adherence. Results: Fourteen (median age 9.1 years; 6F) children were included, 8 (57%) with cerebral palsy, 2 with Rett's syndrome, and 4 with other complex neurological disabilities. Obstructive sleep apnoea was the most common indication for NIV initiation (n = 12). The median (IQR) Apnoea Hypopnoea Index improved on NIV [Pre-NIV 21.3 (IQR 10.0-28.2) vs. Post-NIV 12.2 (IQR 2.8-15.2)], although this was not statistically significant (Figure 1a). There was significant improvement in the proportion of time spent with SpO2 < 95% (Pre-NIV 22.2% vs. 7.85% post-NIV; p < 0.05) (Figure 1b). The sample had high adherence rates and reported side effects were minimal. No reduction in hospital admissions was seen in the 12 months post-NIV initiation. Conclusion: Our findings suggest that NIV improves polysomnography parameters among children with severe neurological disability. Long-term outcomes and overall impact on quality of life remain unclear. Ethical issues and overall benefit must be considered before embarking on this mode of therapy. (Figure Presented).L6377945782022-04-25 <br />