Early prediction of moderate to severe bronchopulmonary dysplasia in extremely premature infants

Amit Sharma; Yuemin Xin; Xinguang Chen; Beena G. Sood

Pediatrics and Neonatology (Jun 2020)

Early prediction of moderate to severe bronchopulmonary dysplasia in extremely premature infants

Amit Sharma,
Yuemin Xin,
Xinguang Chen,
Beena G. Sood

Affiliations

Amit Sharma: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Wayne State University, Detroit, MI 48201, USA; Hutzel Women's Hospital, Detroit, MI 48201, USA; Children's Hospital of Michigan, Detroit, MI 48201, USA
Yuemin Xin: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Wayne State University, Detroit, MI 48201, USA
Xinguang Chen: University of Florida College of Medicine, College of Public Health, USA
Beena G. Sood: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Wayne State University, Detroit, MI 48201, USA; Hutzel Women's Hospital, Detroit, MI 48201, USA; Children's Hospital of Michigan, Detroit, MI 48201, USA; Corresponding author. Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, 3901 Beaubien Blvd., Suite 3N027, Detroit, MI 48201, USA. Fax: +1 313 745 5867.

Journal volume & issue: Vol. 61, no. 3
pp. 290 – 299

Abstract

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Background: Bronchopulmonary Dysplasia (BPD) is the commonest morbidity in extremely preterm infants (PTIs). Risk factors for BPD have been described in the era before the widespread availability of non-invasive ventilation (NIV) in the delivery room (DR). The objective of this study is to identify risk factors for Moderate/Severe BPD in an era of widespread availability of NIV in the DR. Methods: Detailed antenatal and postnatal data were abstracted for PTIs, 230/7–276/7 weeks GA. Multivariate logistic regression and classification and regression tree analyses (CART) identified predictors for the primary outcome of Moderate/Severe BPD. Results: Of 263 eligible infants, 59% had Moderate/Severe BPD. Moderate/Severe BPD was significantly associated with birthweight, gender, DR intubation and surfactant compared to No/Mild BPD. Of infants not intubated in the DR, 40% with No/Mild BPD and 80% with Moderate/Severe BPD received intubation by 48 hours (p < 0.05). Infants with Moderate/Severe BPD received longer duration of oxygen and mechanical (MV). On logistic regression, birthweight, gender, oxygen concentration, cumulative duration of oxygen and MV, surfactant, and blood transfusions predicted Moderate/Severe BPD. Both CART analysis and logistic regression showed duration of oxygen and MV to be the most important predictors for Moderate/Severe BPD. Conclusions: In an era of increasing availability of NIV in the DR, lower birthweight, male gender, surfactant treatment, blood transfusions and respiratory support in the first 2–3 weeks after birth predict Moderate/Severe BPD with high sensitivity and specificity. The majority of these infants received intubation within 48 hours of birth (97%). These data suggest that early failures of NIV represent opportunities for improvement of NIV techniques and of non-invasive surfactant to avoid intubation in the first 48 hours. Furthermore, these risk factors may allow earlier identification of infants most likely to benefit from interventions to prevent or decrease severity of BPD.

Published in Pediatrics and Neonatology

ISSN: 1875-9572 (Print)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Pediatrics
Website: https://www.journals.elsevier.com/pediatrics-and-neonatology/

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