Factors associated with long-term mechanical ventilation in extremely preterm infants

Yossef, Lina; Shepherd, Edward G.; Lynch, Susan K.; Reber, Kristina M.; Nelin, Leif D.

doi:10.3233/npm-181711

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…It is associated with prolonged exposure to MV 6 , and the association between PH and BPD is related to both its pathogenesis (similarly associated to complications of prematurity) and secondary PH development in BPD 24 . There was no difference between groups regarding PDA, NEC, use of VAD, chorioamnionitis and maternal use of tobacco, unlike other studies about both prolonged time under MV and higher severity of BPD 6,20 , which might have occurred due to the relatively small sample size.…”

Section: Discussioncontrasting

confidence: 76%

Influence of Time Under Mechanical Ventilation on Bronchopulmonary Dysplasia Severity in Extremely Preterm Infants: A Pilot Study.

Escobar

Soares

Kreling

et al. 2020

Preprint

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Background: The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) - a common disease in extremely premature newborn (PTNB) - is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and moderate to severe BPD. Methods: 53 PTNB were separated into mild and moderate to severe BPD groups and their data were analyzed. Time under MV with a greater chance of developing moderate to severe BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to moderate to severe BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n=16) by Chi-square test. Results: Time under MV related to a greater chance of developing moderate to severe BPD was 36 days. Moderate to severe BPD group had more males (14 vs 5, p=0,047), longer time under MV (43 vs 19 days, p<0,001), more individuals with PH (12 vs 3, p=0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p=0,003), longer hospital length of stay (109 vs 81,5 days, p<0,001), greater PMA (41 vs 38 weeks, p<0,001) and weight (2620 vs 2031 grams, p<0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p=0,043). Among all variables included in logistic regression, only PH and MV<36 days were significant in the model, explaining 72% of variation in moderate to severe BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the moderate to severe BPD group was 100% (n=6) and 0% in mild BPD group (p=0,0001). Conclusion: Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of moderate to severe BPD.

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Section: Discussioncontrasting

confidence: 76%

Influence of Time Under Mechanical Ventilation on Bronchopulmonary Dysplasia Severity in Extremely Preterm Infants: A Pilot Study.

Escobar

Soares

Kreling

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…It is associated with prolonged exposure to MV 6 , and the association between PH and BPD is related to both its pathogenesis (similarly associated to complications of prematurity) and secondary PH development in BPD [24]. There was no difference between groups regarding PDA, NEC, use of VAD, chorioamnionitis and maternal use of tobacco, unlike other studies about both prolonged time under MV and higher severity of BPD [6,20], which might have occurred due to the relatively small sample size. Additionally, a reasonable number of BPD patients did not survive until they completed 36 weeks PMA, which may also have contributed to this difference in outcomes.…”

Section: Discussionmentioning

confidence: 66%

“…Recent studies have enhanced the harms of exposure for extremely preterm infants to MV for long periods of time. Yossef et al observed that a group of extremely premature infants that were submitted to more than 56 days of MV had a higher incidence of moderate to severe BPD [20]. Choi et al found an almost three-fold increase in the risk of mortality of extremely low birth weight preterm infants who required MV for 15 to 28 days.…”

Section: Discussionmentioning

confidence: 99%

“…Laughon et al in their large study (n = 3629 preterm infants) to develop an instrument for predicting BPD risk and death through clinical information, six variables were relevant to the model: PMA at birth, birth weight, ethnicity, gender, respiratory support and inspiratory oxygen fraction on specific days of hospitalization [10]. Factors such as PMA and weight were also related to longer time under MV 20 . In our search for predictors for development of moderate to severe BPD, in addition to time on MV greater than 36 days, the presence of PH appeared as significant in the regression model.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study

et al. 2020

View full text Add to dashboard Cite

Background: The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD)-a common disease in extremely premature newborn (PTNB)-is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and moderate to severe BPD. Methods: Fifty-three PTNB were separated into mild and moderate to severe BPD groups and their data were analyzed. Time under MV with a greater chance of developing moderate to severe BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to moderate to severe BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n = 16) by Chi-square test. Results: Time under MV related to a greater chance of developing moderate to severe BPD was 36 days. Moderate to severe BPD group had more males (14 vs 5, p = 0,047), longer time under MV (43 vs 19 days, p < 0,001), more individuals with PH (12 vs 3, p = 0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p = 0,003), longer hospital length of stay (109 vs 81,5 days, p < 0,001), greater PMA (41 vs 38 weeks, p < 0,001) and weight (2620 vs 2031 g, p < 0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p = 0,043). Among all variables included in logistic regression, only PH and MV < 36 days were significant in the model, explaining 72% of variation in moderate to severe BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the moderate to severe BPD group was 100% (n = 6) and 0% in mild BPD group (p = 0,0001).

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“…Yossef et al included 210 patients born at < 27 weeks from 2005 to 2011. They further found that long-term intermittent positive pressure ventilation patients were born earlier and had lower birth weight 20 . Markestad et al performed a prospective observational study of 636 infants with a GA of 22–27 weeks or a birth weight of 500–999 g. For the survivors, days of invasive MV decreased from a median of 37 days to 3 days, and the proportion in need of oxygen at 36 weeks’ PMA decreased from 67 to 26% at 23 and 27 weeks’ GA, respectively 21 .…”

Section: Discussionmentioning

confidence: 95%

Effect of different courses and durations of invasive mechanical ventilation on respiratory outcomes in very low birth weight infants

Yang,

Gu,

Lin

et al. 2023

Sci Rep

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This multicenter retrospective study was conducted to explore the effects of different courses and durations of invasive mechanical ventilation (MV) on the respiratory outcomes of very low birth weight infants (VLBWI) in China. The population for this study consisted of infants with birth weight less than 1500 g needing at least 1 course of invasive MV and admitted to the neonatal intensive care units affiliated with the Chinese Neonatal Network within 6 h of life from January 1st, 2019 to December 31st, 2020. Univariate and multivariate logistic regression analyses were performed to evaluate associations between invasive MV and respiratory outcomes. Adjusted odds ratios (ORs) were computed with the effects of potential confounders. (1) Among the 3183 VLBWs with a history of at least one course of invasive MV, 3155 (99.1%) met inclusion criteria and were assessed for the primary outcome. Most infants received one course (76.8%) and a shorter duration of invasive MV (62.16% with ventilation for 7 days or less). (2) In terms of the incidence of all bronchopulmonary dysplasia (BPD) (mild, moderate, and severe BPD), there were no significant differences between different invasive MV courses [For 2 courses, adjusted OR = 1.11 (0.88, 1.39); For 3 courses or more, adjusted OR = 1.07 (0.72, 1.60)]. But, with the duration of invasive MV prolonging, the OR of BPD increased [8–21 days, adjusted OR = 1.98 (1.59, 2.45); 22–35 days, adjusted OR = 4.37 (3.17, 6.03); ≥ 36 days, adjusted OR = 18.44 (10.98, 30.99)]. Concerning severe BPD, the OR increased not only with the course of invasive MV but also with the duration of invasive MV [For 2 courses, adjusted OR = 2.17 (1.07, 4.40); For 3 courses or more, adjusted OR = 2.59 (1.02, 6.61). 8–21 days, adjusted OR = 8.42 (3.22, 22.01); 22–35 days, adjusted OR = 27.82 (9.08, 85.22); ≥ 36 days, adjusted OR = 616.45 (195.79, > 999.999)]. (3) When the interaction effect between invasive MV duration and invasive MV course was considered, it was found that there were no interactive effects in BPD and severe BPD. Greater than or equal to three courses would increase the chance of severe BPD, death, and the requirement of home oxygen therapy. Compared with distinct courses of invasive MV, a longer duration of invasive MV (> 7 days) has a greater effect on the risk of BPD, severe BPD, death, and the requirement of home oxygen therapy.

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Factors associated with long-term mechanical ventilation in extremely preterm infants

Abstract: In this cohort of infants born at <27 weeks gestation 35% were on long term IPPV. There are identifiable factors known on admission and occurring during the NICU stay that are associated with long-term IPPV.

Cited by 4 publications

References 23 publications

Influence of Time Under Mechanical Ventilation on Bronchopulmonary Dysplasia Severity in Extremely Preterm Infants: A Pilot Study.

Influence of Time Under Mechanical Ventilation on Bronchopulmonary Dysplasia Severity in Extremely Preterm Infants: A Pilot Study.

Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study

Effect of different courses and durations of invasive mechanical ventilation on respiratory outcomes in very low birth weight infants

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