Publications by authors named "Christopher D Baker"

Electrical impedance tomography (EIT) is a bedside imaging technique in which voltage data arising from current applied on electrodes is used to compute images of admittivity in real time. Due to the severe ill-posedness of the inverse problem, good spatial resolution poses a challenge in EIT. Conversely, the temporal resolution is high, facilitating dynamic bedside imaging.

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Background: A history of atopy is associated with respiratory morbidities in term-born children; however, little is known about how allergies/atopy affect respiratory outcomes in children with bronchopulmonary dysplasia (BPD). This study aims to describe the prevalence of reported allergies/atopy in young children with BPD and assess whether allergies/atopy are associated with outpatient outcomes.

Methods: A retrospective longitudinal cohort study of children between 0 and 36 months of age followed at outpatient BPD clinics was performed using data from questionnaires administered during routine clinical encounters.

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Objectives: To characterize an observational cohort of ventilator-dependent infants and children with bronchopulmonary dysplasia (BPD) with or without tracheobronchomalacia (TBM) and determine the impact of TBM on the need for ventilator support, liberation from the ventilator and tracheostomy decannulation.

Methods: Demographics and clinical outcomes were obtained by retrospective review from 12 centers participating in the outpatient BPD Collaborative registry. The cohort consisted of infants born between 2016 and 2021 who were dependent on invasive mechanical ventilation at home.

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Objectives: This study seeks to determine the overall and post-intensive care unit (ICU) length of stay (LOS) for children with tracheostomies and chronic mechanical ventilation. We hypothesized that medical and social factors would be associated with prolonged LOS.

Study Design: This single-center retrospective review included children who were discharged after initiation of chronic ventilation via tracheostomy over an 8-year period (2015-2022).

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Article Synopsis
  • - The study focuses on bronchopulmonary dysplasia (BPD), a common chronic respiratory issue in infants, particularly those born preterm, highlighting the lack of consistent clinical care guidelines.
  • - A survey of 27 BPD programs revealed significant variability in outpatient care, including referral processes, services offered, follow-up echocardiograms, and discharge criteria.
  • - The authors advocate for the creation of comprehensive clinical guidelines for BPD, similar to those for asthma and cystic fibrosis, to standardize care and potentially improve long-term health outcomes.
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Article Synopsis
  • The study focused on ventilator-dependent infants and children with bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) to assess their health outcomes.
  • Approximately 60% of the 154 subjects had pulmonary hypertension, with many requiring specific medications; those with PH tended to transition to home ventilation and discharge at older ages.
  • Despite the challenges, most subjects improved over time, successfully weaning off oxygen and ventilators by age 5, with a low mortality rate after discharge.
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  • The study aimed to assess the link between indoor air pollution and respiratory issues in children with bronchopulmonary dysplasia (BPD) under 3 years old.
  • It involved 1,011 participants, with over 40% exposed to indoor pollutants like tobacco smoke and gas stoves, revealing higher odds of emergency visits and antibiotic use associated with secondhand smoke exposure.
  • While acute respiratory problems were related to indoor air pollution, chronic respiratory symptoms and rescue medication use showed no significant association.
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Article Synopsis
  • The study aimed to identify factors affecting when infants with severe bronchopulmonary dysplasia (sBPD) can be liberated from ventilators and successfully decannulated.
  • Results showed that on average, ventilation liberation occurred at 27 months and decannulation at 49 months, with factors like age at discharge, ventilator pressure, and respiratory readmissions influencing these timings.
  • Conclusions highlighted that individual factors predominantly drive the differences in timing, while aggressive management of gastroesophageal reflux affected decannulation timelines.
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Bronchopulmonary dysplasia (BPD) is a chronic lung disease, associated with premature birth, that arises during the infantile period. It is an evolving disease process with an unchanged incidence due to advancements in neonatal care which allow for the survival of premature infants of lower gestational ages and birth weights. Currently, there are few effective interventions to prevent BPD.

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Multidisciplinary bronchopulmonary dysplasia (BPD) programs provide improved and consistent medical management, care of the developing infant, family support, and smoother transitions in care resulting in improved survival, pulmonary, and extra-pulmonary outcomes. This review summarizes the benefits of interdisciplinary BPD management, as well as strategies for initial programmatic development, program growth, and maintenance at centers across the United States factoring in institutional, provider, and parent reported goals that were derived from a consensus conference on BPD management.

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Children using home invasive mechanical ventilation (HIMV), a valuable therapeutic option for chronic respiratory failure, constitute a growing population. Transitioning children using HIMV from hospital to home care is a complex process that requires a multidisciplinary approach involving healthcare professionals, caregivers, and community resources. Medical stability, caregiver competence, and home environment suitability are essential factors in determining discharge readiness.

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Introduction: Children with tracheostomies are high risk for morbidity and mortality. Pediatric resident physicians are not routinely taught skills to care for this vulnerable patient population. Few reports link educational interventions to improved patient outcomes.

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Article Synopsis
  • - This research investigates different mechanical ventilation strategies for infants with severe bronchopulmonary dysplasia (BPD) to improve care and clinical trial design.
  • - A secondary analysis of data from 78 infants across 14 centers used clustering techniques to categorize ventilator settings into three distinct approaches based on specific physiological measures.
  • - The findings show significant differences in ventilation settings among the identified clusters, suggesting a need for further studies to link these practices to BPD clinical outcomes.
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Article Synopsis
  • The study focuses on outpatient respiratory outcomes in children with severe bronchopulmonary dysplasia (BPD) who require tracheostomy and long-term mechanical ventilation.
  • Researchers analyzed data from 155 patients born between 2016 and 2021 across 12 care centers, using methods like Kaplan-Meier analysis to track key respiratory events and assess timing differences among centers.
  • Findings showed significant variability in outcomes such as age at tracheostomy, hospital discharge, and ventilator liberation across different centers, highlighting the need for further research to understand contributing factors to these differences.
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  • A standardized questionnaire was developed to assess respiratory control in preterm infants and children with bronchopulmonary dysplasia (BPD) during outpatient visits, addressing the lack of valid tools for this purpose.
  • Most caregivers (86.2%) reported feeling their child's symptoms were controlled, regardless of BPD severity or history of pulmonary hypertension, indicating broad perceived stability across the population.
  • The questionnaire proved internally reliable and effectively differentiated between levels of symptom control, correlating with healthcare utilization metrics like emergency visits and hospital admissions, suggesting it may be useful for clinical and research applications.
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Article Synopsis
  • BPD is the most common late complication in extremely premature infants, necessitating coordinated care from neonatal intensive care to outpatient services.
  • A survey of 18 academic centers revealed significant differences in how interdisciplinary teams are structured and operate in both inpatient and outpatient settings.
  • Further research is essential to improve long-term outcomes for infants with severe BPD through optimized interdisciplinary care.
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Background: Sharing data across institutions is critical to improving care for children who are using long-term mechanical ventilation (LTMV). Mechanical ventilation data are complex and poorly standardized. This lack of data standardization is a major barrier to data sharing.

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Feeding disorders and gastrostomy use are highly prevalent in children with invasive mechanical ventilation (IMV) due to both common risk factors (eg, prematurity, neurological disorders) and resultant experiential deprivation (eg, long hospitalizations, delayed feeding experiences). Feeding in children with IMV is complicated by the presence of a tracheostomy, lung vulnerability, and medical complexity. The potential comorbidity of swallowing difficulties (dysphagia) and atypical early feeding experiences can result in complex feeding disorders.

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