Longer duration of initial invasive mechanical ventilation is still a crucial risk factor for moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a multicentrer prospective study

Dou, Cong; Yu, Yonghui; Zhuo, Qingcui; Qi, Jianhong; Huang, Lei; Ding, Yanjie; Yang, Dejuan; Li, Li; Li, Dan; Wang, Xiaokang; Wang, Yan; Qiao, Xin; Zhang, Xiang; Zhang, Bingjin; Jiang, Hai-Yan; Li, Zhongliang; Reddy, Simmy

doi:10.1007/s12519-022-00671-w

Cited by 7 publications

(7 citation statements)

References 32 publications

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“…A prospective multicenter cohort study included 6,538 infants born at 23–31 weeks of GA who were admitted to 47 NICUs in China from January 2018 to December 2021. It further revealed that the onset of moderate-to-severe BPD was significantly associated with the duration of initial invasive MV (adjusted OR 1.97; 95% CI 1.10–2.67) 26 . For severe BPD, a single-center, retrospective cohort study included infants born at 22.0–25.9 weeks during 2005–2009 (88 infants in the early era) and 2011–2015 (102 infants in the late era), which was before and after implementing guidelines recommending delayed extubation.…”

Section: Discussionmentioning

confidence: 94%

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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Section: Discussionmentioning

confidence: 94%

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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“…Prolonged duration of ventilation remains a significant factor in severe BPD. A multicenter study reported that the median duration of mechanical ventilation in moderate-to-severe BPD was 26 days whereas the mild BPD group had a median duration of only six days [23]. Lapcharoensap et al, in their study, reported that patients with BPD have a high length of hospitalization compared to those without BPD (103 days vs. 66.5 days) [24].…”

Section: Discussionmentioning

confidence: 98%

Risk Prediction of Severe Bronchopulmonary Dysplasia (BPD) Using the Respiratory Severity Score (RSS) in Extremely Preterm Infants: A Retrospective Study From Saudi Arabia

Abuelsaeed,

Helal,

Almehery

et al. 2024

Cureus

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BackgroundBronchopulmonary dysplasia (BPD) is a significant complication in extremely preterm infants. Therefore, early diagnosis of BPD is important for planning treatment strategies. In this study, we aimed to assess the predictive efficacy of the Respiratory Severity Score (RSS) in determining severe BPD or death outcomes in very preterm infants. MethodologyThis retrospective study included preterm infants born with a gestational age of ≤30 weeks. The inclusion criteria comprised individuals who were mechanically ventilated (<1 week) during the first four weeks of life. Any patients who died during the first seven days of life were excluded. RSS values were recorded on days 3, 14, 21, and 28 of life. Multivariate logistic regression was used to identify a correlation between RSS and patient outcomes. ResultsA total of 154 infants were included in the analysis, of whom 82 (53.24%) developed severe BPD and 38 (24.67%) died. RSS was higher in patients who either died or developed severe BPD compared to those who survived. The multivariate logistic regression analysis revealed that RSSs at postnatal day 14 (odds ratio (OR) = 3.970; 95% confidence interval (CI) = 1.114-14.147; p < 0.05), day 21 (OR = 6.201; 95% CI = 1.937-19.851; p < 0.05), and day 28 (OR = 8.925; 95% CI = 3.331-28.383; p < 0.05) was significantly associated with a higher risk of death or severe BPD. ConclusionsThe findings of the present study revealed that RSS can help predict the risk of severe BPD in very preterm infants.

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“…Mechanical interventions are the mainstay for treating respiratory problems in preterm infants (49)(50)(51). However, recent studies have shown that mechanical ventilation and ventilator-induced lung injury (VILI) are critical risk factors for developing BPD (52).…”

Section: Discussionmentioning

confidence: 99%

Differences in Risk Factors and Predictors of Preterm Twin Infants with Bronchopulmonary Dysplasia: A retrospective study

LI,

DUMBUYA,

CHEN

et al. 2024

Preprint

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Background To evaluate the differences in clinical characteristics, BPD risk factors and predictors in preterm twin infants. Methods A retrospective, single-centre study was conducted on preterm twins admitted to the neonatal intensive care unit (NICU) of The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from January 2021 to December 2022. Data, including perinatal and critical postpartum data, were collected for twin pairs with gestational age (GA) ≤ 31 weeks and birth weight ≤ 2500 g from clinical medical records, including perinatal data and critical postpartum information. Chi-square or nonparametric tests and multiple logistic regression models were used to analyse significant clinical parameters and characteristics for BPD between the two groups and to compare risk factors, respectively. Results A total of 233 twin infants were included in this study. Among them, 183 pairs had BPD, consisting of 366 twin infants. Among twins with BPD, 184 (50.3%) were discordant, and 182 (49.7%) were in one of the twin pairs with BPD. Extremely low birth weight infants (< 1000 g) and extremely preterm infants (GA < 28 weeks) were typical of twin pairs with both BPD (35.9% and 52.7%), while low birth weight infants (< 2500 g) and very preterm infants (GA > 28 < 31 weeks) were more common in one of the twin pairs with BPD (35 .2% and 86.8%). Preterm infants with a length/height between 25 cm and 35 cm were typically twin pairs with BPD (79.7% vs 20.3%). Among the twin pairs with both BPDs, 94 (51.1%) had a head circumference of 22–26 cm compared with 34 (18.7%). Among the risk factors, asphyxia, PDA, RDS, pulmonary hypertension, ROP, IVH, bloodstream infections, hypothyroidism, and hypoproteinaemia were more prevalent in both pairs of twins with BPD. Among the interventions, HFV, IMV, BiPAP, oxygen therapy, and HFNC therapy had significantly different effects on the two groups. The duration of these interventions also significantly differed between the two groups. Conclusions These data demonstrated that risk factors and predictors of BPD in preterm twins vary in magnitude and severity, particularly in extremely low birth weight infants, extremely preterm infants with smaller head circumferences, and infants with short length/height. The need for mechanical ventilation, duration of ventilation, and medication use increased in pairs of twins with both BPD. Thus, this study adds to the existing knowledge on the early detection of risk factors and stratification of clinical management strategies for preterm twins at the individual level.

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Longer duration of initial invasive mechanical ventilation is still a crucial risk factor for moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a multicentrer prospective study

Cited by 7 publications

References 32 publications

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

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

Risk Prediction of Severe Bronchopulmonary Dysplasia (BPD) Using the Respiratory Severity Score (RSS) in Extremely Preterm Infants: A Retrospective Study From Saudi Arabia

Differences in Risk Factors and Predictors of Preterm Twin Infants with Bronchopulmonary Dysplasia: A retrospective study

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