Spinal muscular atrophy type 1: management and outcomes.

Abstract

Our objectives were to describe survival, hospitalization, speech, and outcomes related to respirator needs for spinal muscular atrophy type 1 (SMA1) patients, using noninvasive or tracheostomy ventilation. From 65 SMA patients referred to our clinic since 1996, we chose 56 SMA1 patients who developed respiratory failure before age 2 years. Patients either had tracheostomy tubes (group A), or used noninvasive ventilation and assisted coughing; a previously reported extubation protocol (group B) was used as needed. Sixteen patients underwent tracheostomy at 10.8 +/- 5.0 months of age, 33 were in group B, and 7 others died without life-support interventions. Compared to group B, group A patients had fewer hospitalizations until age 3 years, but more after age 5, and 15 of 16 lost all spontaneous breathing tolerance posttracheostomy and could not speak. One group A patient died at 16 months of age, and the others were 73.8 +/- 57 months of age (the oldest was 19 years old). Two group B patients died at 6 and 13 months, respectively, whereas the other 31 were 41.8 +/- 26.0 months (and up to 8.3 years) old. Three of 31 in group B required high-span positive inspiratory pressure plus positive end-expiratory pressure (PIP + PEEP) continuously with minimal tolerance for breathing on their own, and 4 could not communicate verbally.In conclusion, SMA type 1 children can survive beyond 2 years of age when offered tracheostomy or noninvasive respiratory support. The latter is associated with fewer hospitalizations after age 5 years, freedom from daytime ventilator use, and the ability to speak.

• Authors: John R Bach, J Scott Baird, Daniel Plosky, Jose Navado, Brian Weaver
• Journal: Pediatric pulmonology (Pediatr Pulmonol) Vol. 34 Issue 1 Pg. 16-22 (Jul 2002) ISSN: 8755-6863 [Print] United States
• PMID: 12112792 (Publication Type: Journal Article)
• Copyright: Copyright 2002 Wiley-Liss, Inc.

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Female
• Humans
• Infant
• Male
• Positive-Pressure Respiration
• Respiratory Insufficiency (etiology)
• Spinal Muscular Atrophies of Childhood (complications, mortality, therapy)
• Survival Rate
• Tracheostomy
• Treatment Outcome
• Ventilators, Mechanical