Determinants of chronic lung disease severity in the first year of life; A population based study

Gage, Susan; Kan, Peiyi; Oehlert, John; Gould, Jeffrey B.; Stevenson, David K.; Shaw, Gary M.; O’Brodovich, Hugh

doi:10.1002/ppul.23148

Cited by 19 publications

(15 citation statements)

References 40 publications

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“…In general, research on pulmonary outcomes at 1–2 years in former preterm infants has focused on separate aspects of respiratory morbidity or lung function (4, 8, 14, 35–38). More recently, Gage et al proposed a respiratory morbidity scoring system for former preterm infants at 4–9 months corrected age (39). From this, they determined low, moderate and severe categories of morbidity, which, when compared with no morbidity were consistently associated with neonatal systemic steroid use, with less consistent relationships with gestational age, male sex, race/ethnicity, initial resuscitation and severity of respiratory illness.…”

Section: Discussionmentioning

confidence: 99%

Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study

Keller

Feng

DeMauro

et al. 2017

The Journal of Pediatrics

164

169

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Objective To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGAN). Study Design We enrolled ELGAN (<29 weeks’ gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks’ post-menstrual age. We surveyed caregivers at 3, 6, 9 and 12 months corrected age to identify post-discharge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheotomy, ventilation), medications, or symptoms (cough/wheeze). Infants were classified as post-prematurity respiratory disease (PRD, the primary study outcome), if respiratory morbidity persisted over ≥2 questionnaires. Infants were classified with severe respiratory morbidity if there were multiple hospitalizations, exposure to systemic steroids or pulmonary vasodilators, home oxygen after 3 months or mechanical ventilation, or symptoms despite inhaled corticosteroids. Mixed effects models generated with data available at one day (perinatal) and 36 weeks’ postmenstrual age were assessed for predictive accuracy. Results Of 724 infants (918±234g, 26.7±1.4 weeks’ gestational age) classified for the primary outcome, 68.6% had PRD; 245/704 (34.8%) were classified as severe. Male sex, intrauterine growth restriction, maternal smoking, race/ethnicity, intubation at birth, and public insurance were retained in perinatal and 36-week models for both PRD and respiratory morbidity severity. The perinatal model accurately predicted PRD (c-statistic 0.858). Neither the 36-week model nor the addition of bronchopulmonary dysplasia (BPD) to the perinatal model improved accuracy (0.856, 0.860); c-statistic for BPD-alone was 0.907. Conclusion Both BPD and perinatal clinical data accurately identify ELGAN at risk for persistent and severe respiratory morbidity at one year. Trial registration ClinicalTrials.gov: NCT01435187

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Section: Discussionmentioning

confidence: 99%

Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study

Keller

Feng

DeMauro

et al. 2017

The Journal of Pediatrics

164

169

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“…For preterm infants, a diagnosis of BPD is more akin to a functional lung assessment at the time a preterm infant is expected to transition out of hospital (similar to how forced expiratory volume in 1 second (FEV1) is used in conditions such as cystic fibrosis) 105 . More than 30 years after BPD was defined by Shennan et al 106 , how well a BPD diagnosis can predict pulmonary outcomes in infancy and childhood, and how those long-term pulmonary outcomes should be defined, remain primary research and clinical questions 107 .…”

Section: Current Challenges In Defining Bpd-for Most Diseases Diagnmentioning

confidence: 99%

Bronchopulmonary dysplasia

Thébaud

Goss

Laughon

et al. 2019

Nat Rev Dis Primers

672

652

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The strongest risk factors for BPD are prematurity and low birth weight 19-25. Almost 80% of infants who are born at 22-24 weeks of gestation are diagnosed with BPD 26 , whereas only 20% of infants born at 28 weeks of gestation develop BPD. Among infants with BPD, 95% are VLBW 27. Other perinatal risk factors include intrauterine growth restriction (IUGR) 13 , male sex 13,20,23 and, inconsistently, chorioamnionitis 28 , race or ethnicity 13,20,23 , and smoking 29,30. Genetic risk factors may also contribute to the development of BPD, as indicated by twin studies 31,32 , and there is an ongoing search for genetic markers for BPD 33-37. Early respiratory patterns of premature infants provide insight into risk factors for BPD. An early study suggested that peak inspiratory ventilator pressure and requirement for assisted ventilation on day 4 of life are early predictors of BPD 38. Subsequent studies found that three patterns of lung disease generally emerge in the first 2 weeks of life 39-45 (FIG. 2). In the first pattern, infants have fairly minimal lung disease and progressively recover. In the second pattern, early persistent pulmonary deterioration (EPPD), substantial and prolonged respiratory support is required from birth. In the third pattern, an initial improvement in lung disease in the first week of life is followed by a respiratory decompensation termed pulmonary deterioration, which often requires mechanical ventilation and an increase in supplemental oxygen. Risk factors that may be associated with pulmonary deterioration include late surfactant deficiency 46 , sepsis, increased levels of inflammatory proteins (such as RANTES) 47 and patent ductus arteriosus 40,43. Almost 50% of infants with pulmonary deterioration and almost 70% of infants with EPPD develop BPD 48. The National Institute of Child Health and Human Development (NICHD) Neonatal Research Network developed an online, publicly available risk estimator (https:// neonatal.rti.org/index.cfm) that accurately estimates the risk of developing BPD by postnatal day 49. Investigators identified risk factors for BPD, and the competing outcome of death, among gestational age, birth weight, ethnicity and sex, ventilatory support (ranging from no support (breathing room air without positive airway pressure) to high frequency ventilation) and fraction of inspired oxygen (FiO 2), on postnatal days 1, 3, 7, 14, 21 and 28 in 3,636 infants born at 23-30 weeks of gestation. The BPD prediction tool is internally and externally validated. The models predict the correct level of BPD or the occurrence of death in >80% of cases and have the highest area under the curve (AUC) among current BPD risk predictors 50. This tool is used to provide counselling to families and to quantify risk for determining patient inclusion in early phase therapeutic trials. Interestingly, systemic inflammation occurs early in the neonatal period and precedes clinical symptoms in infants with BPD 51. This finding suggests that a therapeutic window of opportunity exists during the early p...

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“…Duration of mechanical ventilation, but not duration of oxygen supplementation, correlates with increased ventilation/perfusion mismatch (single photon emission computed tomography) at 37 weeks postmenstrual age in infants with BPD [20]. In later childhood, duration of mechanical ventilation is associated with reduced forced vital capacity, increased functional residual capacity and bronchial hyperresponsiveness [20][21][22][23][24].…”

Section: Long-term Outcomes Of Neonatal Respiratory Therapies: Lessonmentioning

confidence: 99%

How best to capture the respiratory consequences of prematurity?

2018

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Chronic respiratory morbidity is a common complication of premature birth, generally defined by the presence of bronchopulmonary dysplasia, both clinically and in trials of respiratory therapies. However, recent data have highlighted that bronchopulmonary dysplasia does not correlate with chronic respiratory morbidity in older children born preterm. Longitudinally evaluating pulmonary morbidity from early life through to childhood provides a more rational method of defining the continuum of chronic respiratory morbidity of prematurity, and offers new insights into the efficacy of neonatal respiratory interventions. The changing nature of preterm lung disease suggests that a multimodal approach using dynamic lung function assessment will be needed to assess the efficacy of a neonatal respiratory therapy and predict the long-term respiratory consequences of premature birth. Our aim is to review the literature regarding the long-term respiratory outcomes of neonatal respiratory strategies, the difficulties of assessing dynamic lung function in infants, and potential new solutions.

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Determinants of chronic lung disease severity in the first year of life; A population based study

Cited by 19 publications

References 40 publications

Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study

Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study

Bronchopulmonary dysplasia

How best to capture the respiratory consequences of prematurity?

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