title: A comparison of invasive and noninvasive ventilation in children less than 1 year of age: A long-term follow-up study.
abstract: BACKGROUND
  We report on the long-term survival of children initiated on invasive and noninvasive positive pressure ventilation (NiPPV) before the age of 1 to assess the safety and efficacy of long-term ventilation at home.
  
  
  METHODS
  A chart review was performed of children initiated on long-term home mechanical ventilation (LTHV) before the age of 1 year, at The Hospital for Sick Children (SickKids), Canada, between January 1991 and April 2014.
  
  
  RESULTS
  We report on 51 children. Twenty-five children (49%) received NiPPV and 26 (51%) received invasive mechanical ventilation via tracheostomy (IMV). There was one NiPPV initiation between 1991 and 2001, the rest were in subsequent years. Most children had a "musculoskeletal disorder" in the NiPPV cohort, n = 14 (56%) and a "central nervous system" disorder in the IMV cohort, n = 13 (50%). The pCO2 improved with the initiation of NiPPV, P = < 0.0001. Of the 25 subjects initiated on NiPPV, eight (32%) are currently being followed as compared to 22 (84%) in the IMV cohort. Seven (28%) of the NiPPV group were weaned off ventilation as compared to three (11.5%) in the IMV cohort. There were two NiPPV treatment failures. There were more deaths in the NiPPV cohort: eight (32%) versus two (7.6%) in the IMV cohort. Four of the deaths in the NiPPV cohort were in children in whom a palliative approach was taken. None were due to NiPPV technical failure.
  
  
  CONCLUSIONS
  Based on this long-term follow-up study, NiPPV use in infants appears to be a viable long-term ventilation strategy.
authors.affiliation: Divisionof Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.|Department of Pediatrics, University of Toronto, Toronto, Canada.
authors.forename: Tamizan
authors.initials: T
authors.lastname: Kherani
authors.affiliation: Divisionof Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Aarti
authors.initials: A
authors.lastname: Sayal
authors.affiliation: Divisionof Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.|Department of Pediatrics, University of Toronto, Toronto, Canada.
authors.forename: Suhail
authors.initials: S
authors.lastname: Al-Saleh
authors.affiliation: Divisionof Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Priya
authors.initials: P
authors.lastname: Sayal
authors.affiliation: Divisionof Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.|Department of Pediatrics, University of Toronto, Toronto, Canada.
authors.forename: Reshma
authors.initials: R
authors.lastname: Amin
mesh_terms: D002170:Canada; D002493:Central Nervous System Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy; D008297:Male; D009140:Musculoskeletal Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy; D009468:Neuromuscular Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy; D063087:Noninvasive Ventilation / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D014139:Tracheostomy
keywords: neuromuscular; non-invasive; pediatric; ventilation