Interstitial pneumonia pattern on day 7 chest radiograph predicts bronchopulmonary dysplasia in preterm infants

Abstract

BackgroundEarly identification of infants at higher risk of developing bronchopulmonary dysplasia (BPD) may enable a targeted approach to reduce BPD. We aimed to evaluate the hypothesis that the interstitial pneumonia pattern on the day 7 chest radiograph predicts BPD or death before 36 weeks postmenstrual age (PMA).MethodsA retrospective cohort study was performed on 336 preterm infants (birth weight < 1500 g and gestational age < 32 postmenstrual weeks) who were admitted to a single tertiary academic center between January 2008 and December 2014. Day 7 chest radiographs were independently reviewed by two pediatric radiologists who were unaware of the clinical information regarding each individual infant.ResultsData from 304 infants who survived more than 7 days after birth were collected. The interstitial pneumonia pattern on the day 7 chest radiograph was independently associated with BPD or death before 36 weeks PMA (odds ratio [OR] 4.0, 95% confidence interval [CI] 1.1–14.4). The interstitial pneumonia pattern on the day 7 chest radiograph predicted BPD or death with a specificity of 98%. Histologic chorioamnionitis was a preceding factor that was independently associated with the interstitial pneumonia pattern on the day 7 chest radiograph (OR 3.7, 95% CI 1.3–10.3).ConclusionsThe interstitial pneumonia pattern on the day 7 chest radiograph has a high specificity for predicting BPD or death and can be utilized to select high-risk preterm infants who will benefit from potentially preventive interventions against BPD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-017-0881-1) contains supplementary material, which is available to authorized users.

Lung ultrasound score as early predictor of bronchopulmonary dysplasia in very low birth weight infants

“…Using thoracic X‐ray, Kim et al reported that the existence of an interstitial infiltrate at 7 DOL predicts the later development of BPD in VLBWI . This interstitial infiltrate in the thoracic X‐ray correlates well with the existence of multiple B‐lines in LU .…”

“…Detecting early signs of this lung disease is challenging, and in the absence of a reliable marker for this evolving disorder, a window of opportunity to provide specific treatment or further adapt respiratory support is often missed. Cytokines and various proteins in blood or tracheal aspirate, as well as thoracic X‐rays have been studied as potential biomarkers for BPD, but none has been proven sufficiently robust to be utilized in clinical practice.…”

“…support is often missed. Cytokines and various proteins in blood or tracheal aspirate, 2,3 as well as thoracic X-rays 4 have been studied as potential biomarkers for BPD, but none has been proven sufficiently robust to be utilized in clinical practice.…”

Impact of chest radiography‐based definition of bronchopulmonary dysplasia

“…Second, the chest radiograph classification did not have a scoring system. It has also been reported that the simple scoring or appearance of chest radiograph on postnatal day 7 predicts BPD36 . BPD36 was predicted using a simple BPD scoring systems resembling the present chest radiograph classification, using terms such as emphysematous/fibrous or hazy appearance .…”

“…It has also been reported that the simple scoring or appearance of chest radiograph on postnatal day 7 predicts BPD36. 12,13 BPD36 was predicted using a simple BPD scoring systems resembling the present chest radiograph classification, using terms such as emphysematous/fibrous or hazy appearance. 12,13 Therefore, further studies to identify simple scoring systems correlated with bubbly/cystic appearance on chest radiograph are required to validate the present chest radiograph classification.…”