48: Does the Use of NiPPV Decrease the Number of Pneumonia Episodes in Patients with Static or Progressive Neurological Disease?
Bibliographic record
Abstract
Non-invasive positive pressure ventilation (NiPPV) refers to the administration of inspiratory and expiratory pressure support via a properly fitting facial mask. NiPPV is helpful in treating obstructive sleep apnea and impaired gas exchange due to hypoventilation in children with progressive neurologic diseases such as Duchenne muscular dystrophy, spinal muscular atrophy or myotonic dystrophy. However, in these children, recurrent pneumonias due to hypoventilation and impaired cough clearance can also lead to significant morbidity and mortality. To our knowledge, there have been few studies of the potential reduction in incidence of pneumonias following the use of home nocturnal NiPPV in children with an underlying neurological or neuromuscular disease. Our objective was to identify a change in the rate of pneumonias before and after the initiation of NiPPV in children with neurologic or neuromuscular conditions. We aimed to determine if the number of hospitalizations for respiratory illnesses two years prior to the initiation of NiPPV decreased compared to the number of hospitalizations two years after the initiation of NiPPV. This was a retrospective single-institution chart review study. Patients aged one to 18 years with an underlying neurological or neuromuscular disease and who had been prescribed nocturnal NiPPV were included. Patients were identified through the clinical records of their treating pediatric respirology and neurology physicians. We excluded subjects with a tracheostomy, or those using NIPPV solely for the treatment of obstructive sleep apnea. Pre and post pneumonia rates were compared via paired t-tests. Twenty-nine patients were eligible for this study, but fifteen were removed because they met the exclusion criteria. For the remaining fourteen patients, the mean number of pneumonias two years before the initiation of NiPPV was 1.71 (SD = 3.29), and the mean number of pneumonias two years after initiation was 2.07 (SD = 2.79). The difference between the pre and post NiPPV rates of pneumonias was not significant (P=0.59). The sample size was too small to examine disease subgroups. There was no statistically significant difference between the number of episodes of pneumonia before and after the initiation of non-invasive positive pressure ventilation in children with neurologic or neuromuscular conditions at our tertiary care pediatric institution. The small sample size, and/or the potential confounding factor of advancing disease severity over the observation period, potentially impacted our ability to identify differences in rates of pneumonia admissions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".