Clinical outcomes of paediatric home ventilation in South Korea: liberation and mortality.

Abstract

Background: The number of children receiving home ventilation (HV) has substantially increased, many with neuromuscular diseases (NMDs). Understanding outcomes in this population is critical for guiding care and policy decisions. However, real-world data from South Korea are scarce, limiting evaluation of the 2016 national insurance expansion.

Objectives: We aimed to investigate characteristics and outcomes of paediatric HV after insurance expansion, focusing on differences by NMD status and to identify key factors associated with HV liberation and mortality.

Methods: We conducted a single-centre retrospective cohort study at Seoul National University Children's Hospital. We included children aged <19 years who received a Health Insurance or Medical Aid Ventilator Prescription between 1 January 2016 and 30 September 2024. Primary outcomes were HV liberation and all-cause mortality. Kaplan-Meier estimates with log-rank tests were used for between-group comparisons. Multivariable Cox regression was applied to identify factors associated with outcomes, reporting adjusted HRs (aHRs) and 95% CIs.

Results: Among 316 children, 89 (28.2%) had NMDs. During follow-up, 71 (22.5%) were liberated and 81 (25.6%) died. Reduced likelihood of liberation was associated with NMD, home nursing care and gastrostomy, whereas oxygen use at HV initiation increased likelihood. NMD was not significantly associated with mortality (aHR 0.97 (95% CI 0.48 to 1.96)). Mortality risk was reduced with preterm birth, home nursing care and airway anomalies, but increased with antiseizure medication and continuous ventilation.

Conclusion: NMD was linked to lower liberation likelihood but not mortality. Several other clinical factors were associated with outcomes, underscoring the need for individualised care strategies for paediatric HV.