472 - A multi-disciplinary care program enhances care and outcomes for infants from historically marginalized populations with chronic respiratory failure in a Level IV Neonatal Intensive Care Unit.

Poster Number: 472
Publication Number: 472.433

Douglas Bush, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Evelyne M. St. John Sutton, Icahn School of Medicine at Mount Sinai, New York, NY, United States; John Bucuvalas, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Courtney Juliano, Icahn School of Medicine at Mount Sinai, New york, NY, United States

Background: Morbidity and mortality are associated with very low birth weight and premature birth, both of which occur more frequently in historically marginalized populations (HMP). The relative contribution of clinical complexity, system barriers and care processes likely varies among the population and strategies to mitigate risk and improve outcome require personalized care recognizing system and home constraints.

Objective: To evaluate the impact of a personalized, family-centered, multidisciplinary chronic lung care program on HMP with chronic respiratory failure in a neonatal intensive care unit (NICU).

Design/Methods: Inborn and outborn (transferred in) infants with chronic respiratory failure (CRF), were identified by the need for respiratory support at 36 weeks corrected gestational age in prematurely born infants or anticipated need for long-term respiratory support in term infants, were enrolled in the multidisciplinary Chronic Lung Care Program (CLCp) beginning in 2019. The primary outcomes of death or tracheostomy tube dependence were determined each year for all infants and subgroups as defined by ethnicity. Care provision by the CLCp centers on weekly multidisciplinary rounds that include parents, neonatologists, pediatric pulmonologists, and therapists for all enrolled patients, with a model of shared decision-making and a holistic approach to care driving clinical strategies.

Results: In the year prior to CLCP, 4 inborn infants with BPD required tracheostomy, all from HMP, 3 of these infants died (Table 1). In 2019, 6 infants were diagnosed with CRF, 83% of which were from HMP, 5 required tracheostomy tubes with zero deaths. In 2020, 9 infants were diagnosed with CRF, 66% from HMP with 5 requiring tracheostomy tubes and zero deaths. 2020 saw 7 infants with CRF enrolled in the CLCp, 86% from HMP, 5 requiring tracheostomy tubes and zero deaths.Conclusion(s): Chronic respiratory failure confers significant risk of morbidity and mortality in ex-preterm and term infants. In our level IV NICU, infants from historically marginalized populations are disproportionately impacted (Figure 1). Our preliminary efforts demonstrate the positive impact of establishment of a multidisciplinary chronic lung care program on critical outcomes for this vulnerable population.
Demographic and clinical characteristicsDemographic and clinical characteristics of neonates with chronic respiratory failure enrolled in a Chronic Lung Care program.
Ethnicity of neonates with chronic respiratory failureFigure 1. Ethnic diversity of neonates (n=22) with chronic respiratory failure in a level IV NICU (n=22) enrolled in a multidisciplinary chronic lung care program.