The Pandemic Allocation of Ventilators Model Penalizes Infants with Bronchopulmonary Dysplasia
During the COVID-19 pandemic, institutions developed ventilator allocation models. In one proposed model, neonates compete with adults for ventilators using a scoring system. Points are given for conditions that increase one- and five-year (y) mortality. For example, comparable points were added for...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-08-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/10/8/1404 |
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| author | Anupama Sundaram Jonathan M. Fanaroff Deanne Wilson-Costello Melissa Alberts Naini Shiswawala Noam Stern Rita M. Ryan |
| author_facet | Anupama Sundaram Jonathan M. Fanaroff Deanne Wilson-Costello Melissa Alberts Naini Shiswawala Noam Stern Rita M. Ryan |
| author_sort | Anupama Sundaram |
| collection | DOAJ |
| description | During the COVID-19 pandemic, institutions developed ventilator allocation models. In one proposed model, neonates compete with adults for ventilators using a scoring system. Points are given for conditions that increase one- and five-year (y) mortality. For example, comparable points were added for adult conditions with mortality of 71.3% and for neonates with moderate or severe bronchopulmonary dysplasia (mod/sBPD). We hypothesized that this model overestimates mortality in neonates with BPD and would penalize these infants unfairly. There was little information available on 1 y and 5 y mortality risk for mod/sBPD. To evaluate this allocation protocol, a retrospective chart review was performed on infants born ≥22 weeks and weighing <1500 g admitted to Rainbow Babies and Children’s Hospital in 2015 to identify babies with BPD. The main outcomes were 1 and 5 y mortality. In 2015, 28 infants were diagnosed with mod/s BPD based on NIH 2001 definition; 4 infants had modBPD and 24 had sBPD. All infants (100%) with modBPD survived to 5 y; 2 infants with sBPD died by 1 y (8%) and 22 survived (92%) to 1 y; 3 died (12.5%) by 5 y; and at least 13 survived (54%) to 5 y. Infants with mod/s BPD had lower-than-predicted 1 and 5 y mortality, suggesting the points assigned in the model are too high for these conditions. We believe this model would unfairly penalize these babies. |
| first_indexed | 2024-03-11T00:02:34Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-11T00:02:34Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-a1ac838f64534287913513af768544c22023-11-19T00:41:05ZengMDPI AGChildren2227-90672023-08-01108140410.3390/children10081404The Pandemic Allocation of Ventilators Model Penalizes Infants with Bronchopulmonary DysplasiaAnupama Sundaram0Jonathan M. Fanaroff1Deanne Wilson-Costello2Melissa Alberts3Naini Shiswawala4Noam Stern5Rita M. Ryan6Department of Neonatology, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH 44106, USADepartment of Neonatology, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH 44106, USADepartment of Neonatology, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH 44106, USADepartment of Neonatology, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH 44106, USADepartment of Neonatology, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH 44106, USADepartment of Neonatology, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH 44106, USADepartment of Neonatology, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH 44106, USADuring the COVID-19 pandemic, institutions developed ventilator allocation models. In one proposed model, neonates compete with adults for ventilators using a scoring system. Points are given for conditions that increase one- and five-year (y) mortality. For example, comparable points were added for adult conditions with mortality of 71.3% and for neonates with moderate or severe bronchopulmonary dysplasia (mod/sBPD). We hypothesized that this model overestimates mortality in neonates with BPD and would penalize these infants unfairly. There was little information available on 1 y and 5 y mortality risk for mod/sBPD. To evaluate this allocation protocol, a retrospective chart review was performed on infants born ≥22 weeks and weighing <1500 g admitted to Rainbow Babies and Children’s Hospital in 2015 to identify babies with BPD. The main outcomes were 1 and 5 y mortality. In 2015, 28 infants were diagnosed with mod/s BPD based on NIH 2001 definition; 4 infants had modBPD and 24 had sBPD. All infants (100%) with modBPD survived to 5 y; 2 infants with sBPD died by 1 y (8%) and 22 survived (92%) to 1 y; 3 died (12.5%) by 5 y; and at least 13 survived (54%) to 5 y. Infants with mod/s BPD had lower-than-predicted 1 and 5 y mortality, suggesting the points assigned in the model are too high for these conditions. We believe this model would unfairly penalize these babies.https://www.mdpi.com/2227-9067/10/8/1404bronchopulmonary dysplasiatriageresource allocation |
| spellingShingle | Anupama Sundaram Jonathan M. Fanaroff Deanne Wilson-Costello Melissa Alberts Naini Shiswawala Noam Stern Rita M. Ryan The Pandemic Allocation of Ventilators Model Penalizes Infants with Bronchopulmonary Dysplasia Children bronchopulmonary dysplasia triage resource allocation |
| title | The Pandemic Allocation of Ventilators Model Penalizes Infants with Bronchopulmonary Dysplasia |
| title_full | The Pandemic Allocation of Ventilators Model Penalizes Infants with Bronchopulmonary Dysplasia |
| title_fullStr | The Pandemic Allocation of Ventilators Model Penalizes Infants with Bronchopulmonary Dysplasia |
| title_full_unstemmed | The Pandemic Allocation of Ventilators Model Penalizes Infants with Bronchopulmonary Dysplasia |
| title_short | The Pandemic Allocation of Ventilators Model Penalizes Infants with Bronchopulmonary Dysplasia |
| title_sort | pandemic allocation of ventilators model penalizes infants with bronchopulmonary dysplasia |
| topic | bronchopulmonary dysplasia triage resource allocation |
| url | https://www.mdpi.com/2227-9067/10/8/1404 |
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