Post-N/IICU BPD Clinical Pathway – Inpatient | Children's Hospital of Philadelphia

Related Pathway

Pulmonary Hypertension Screening in Patients with BPD, ICU and Inpatient

N/IICU Infants with Severe Bronchopulmonary Dysplasia (BPD) on ≤ 4 L HFNC

Review Criteria for Transfer from N/IICU

High flow nasal cannula flow of ≤ 4 LPM and ≤ 40% FiO₂ for at least 24 hrs with stable respiratory status and appropriate growth
No significant bradycardia/desaturation/apnea events
Pulmonary hypertension stable on enteral meds
No imminent neurosurgical interventions planned
Limited changes to the care plan for 24–48 hrs prior to anticipated transfer

Consult

Pulmonary BPD Team
Complex Care Blue Team

Prepare family for transfer; consider family transition meeting
Initiate bed request for Complex Care Blue when bed available
N/IICU hand-off to Complex Care

Transfer to Complex Care Blue Team

Assess Readiness to Wean Every 5–7 Days

Trends in O₂ saturations, FiO₂ needs, RR, resting HR
All growth parameters
Ability to tolerate and progress with therapies
Recommendations from Pulmonary BPD team

Feeding and Nutrition

Allow infant to adjust to weaning of respiratory support; avoid changing feeding regimen for 1–2 days following wean

Failure to Wean

Return to previously tolerated level of support
Review differential diagnosis
Review with Pulmonary BPD Team
Reattempt wean when stable

Wean Respiratory Support When Clinically Appropriate
Step	LPM
1	4	HFNC with Blended O₂
2	3	HFNC with Blended O₂
3	2	FiO₂ 100% Delivery via NC from oxygen source provides lower effective FiO₂ than 100%
4	1
5	0.5
6	RA	0.25 LPM (FiO₂ 100%) may be an intermediate step prior to RA depending on infant condition and discussion with Pulmonary BPD team

Successful Wean to Discharge Level of Respiratory Support
RA preferred; may consider ≤ 0.5 LPM in discussion with Pulmonary BPD team

Monitor tolerance
Observe infant for minimum of 3 days

Discharge Planning

Posted: April 2022
Last Revised: August 2025
Authors:
- M. Dunn, MD
- P. Mazzeo, MD
- K. Gibbs, MD
- K. Mckenna, MD
- A. Hogan, MD
- D. Tauber, MD
- J. Fierro, MD
- J. Welc, CCC-SLP
- K. Nilan, RN
- A. Karkoska, RN
- K. Matthews, RRT
Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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Inpatient Clinical Pathway for the Post-N/IICU Management of Infants with Severe Bronchopulmonary Dysplasia (BPD)

Evidence