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

Abstract

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).

Duration of mechanical ventilation and prediction of bronchopulmonary dysplasia and home oxygen in extremely preterm infants

“…The differences in that study with the current whole‐population study might be explained by a larger variation of clinical practice and the smaller gestational age of the included infants in the current whole‐population study. Escobar et al recently studied 53 extremely premature infants and reported that a duration of ventilation exceeding 36 days was related to a greater chance of developing moderate‐to‐severe BPD, a finding which was consequently confirmed in a small validation sample of 16 extremely preterm infants 17 . In that smaller study, however, the prediction time point was relatively late in postnatal life compared with our study (36 compared to 8 days).…”

“…Escobar et al recently studied 53 extremely premature infants and reported that a duration of ventilation exceeding 36 days was related to a greater chance of developing moderate-to-severe BPD, a finding which was consequently confirmed in a small validation sample of 16 extremely preterm infants. 17 In that smaller study, however, the prediction time point was relatively late in postnatal life compared with our study (36 compared to 8 days). Our results are also in agreement with Jensen et al who studied 3,343 extremely low-birthweight infants and reported that among the survivors, exposure to a greater number of mechanical ventilation courses was associated with a progressive increase in the risk of BPD and use of supplemental oxygen at discharge.…”

Using a Bundle Approach to Prevent Bronchopulmonary Dysplasia in Very Premature Infants

“…Mechanical ventilation has been shown to increase the risk of BPD, mortality rates, the need for oxygen after discharge, and rates of other complications such as periventricular leukomalacia and retinopathy of prematurity 16,20. A longer cumulative duration of mechanical ventilation has been found to have the greatest impact on BPD rates, supporting the practice of early extubation trials, even if the infant might ultimately need to be reintubated 16,21. Noninvasive ventilation can be used successfully in the delivery room for very premature infants and can decrease BPD rates, even if intubation is needed at a later time 21,22.…”

Research Progress in Bronchopulmonary Dysplasia: A Narrative Review by Etiology

“…In preterm neonates with extremely low birth weight exposed to more than six weeks of MV, mortality risk increases 8-fold. The risk rises by thirteen times when stratified for only cardiorespiratory causes [27]. Every extra week a neonate spends on MV raises the risk of developing BPD by 2.7 fold.…”