New Insights on Early Patterns of Respiratory Disease among Extremely Low Gestational Age Newborns

Abstract

Background: The analysis of early patterns of lung disease among preterm infants may help to identify predictors of pulmonary deterioration. Objectives: To analyze FIO₂ requirement in the first 14 days of life among preterm infants and to find predictors of bronchopulmonary dysplasia (BPD). Methods: Retrospective cohort study. Setting: 3 Italian level III NICUs. Population: infants born between 24^0/7 and 27^6/7 weeks' gestational age (GA) who survived to 14 days. A consecutive sample of 588 infants was analyzed. Daily mode FIO₂ in the first 2 weeks of life were analyzed according to the criteria defined by Laughon et al. [Pediatrics 2009;123:1124-1131], who found 3 early respiratory patterns: consistently low FIO₂ (LowFIO₂), pulmonary deterioration (PD), and early persistent pulmonary deterioration (EPPD). Factors associated with pulmonary deterioration were studied by univariate and multivariate analysis. Results: Forty percent of infants had low FIO₂, 18% had pulmonary deterioation, 21% had early persistent pulmonary deterioration, and 21% had a previously unreported pattern (pulmonary improvement, PI). The prevalence of BPD was 7% in the LowFIO₂ group, 28% in the PI group, 44% in the PD group, and 62% in the EPPD group (p = 0.000). Infants with lung deterioration were more frequently males (OR = 2.019, CI: 1.319-3.090, p = 0.001), had lower GA (OR = 0.945, CI: 0.915-0.975, p = 0.000), higher incidence of severe respiratory distress syndrome (OR = 2.956, CI: 1.430-6.112, p = 0.003), and lack of postnatal caffeine (OR = 0.167, CI: 0.052-0.541, p = 0.003). Conclusions: We report 4 distinct patterns of early respiratory disease associated with significantly different prevalence of BPD and discuss risk factors for lung deterioration.

Oxygen saturation/FIO2 ratio at 36 weeks’ PMA in 1005 preterm infants: Effect of gestational age and early respiratory disease patterns

“…To date, no published studies have investigated long‐term pulmonary outcome in preterm infants with different ERP. We found that the degree of prematurity, which is strongly associated with ERP as we previously showed, was significantly associated with 36w‐SFR only among infants without BPD. Among infants with BPD, there was a non‐significant direct correlation between GA at birth and 36w‐SFR.…”

“…Moreover, perinatal risk factors related to growth restriction and inflammation may increase the risk of BPD in preterm infants . We previously showed that human milk feeding was associated with less severe ERP, as it may contain trophic factors that might protect the lungs from injuries and improve lung and vascular growth . Given the results of this study, we speculate that the beneficial effects of human milk are sustained and result in a more efficient oxygen diffusion at 36 weeks’ PMA.…”

“…The severity of ERP was also associated with 36w‐SFR. ERP are in turn influenced by a variety of factors, including demographics (male sex, early gestational age), drugs (ie, caffeine), RDS severity, and prolonged endotracheal ventilation …”

“…We recently described four early respiratory disease patterns (ERP) which were associated with different prevalence of BPD (LowFIO 2 , Pulmonary Improvement‐PI, Pulmonary Deterioration‐PD, Early Persistent Pulmonary Deterioration‐EPPD) …”

Designing a better definition of bronchopulmonary dysplasia

“…The authors noted that the SFR values at 36 weeks (36w‐SFR) was significantly different between BPD (using the “physiologic” definition) and non‐BPD infants [371 [316‐419] vs 467 [460‐471]; P < 0.001]. In addition, the 36w‐SFR also was significantly different according to the early respiratory disease patterns (ERP), as described in an earlier publication by the same group of investigators . Significant differences were found both in BPD and in non‐BPD patients according to ERP in the study by Nobile et al (Figure 2; P < 0.001; the Kruskal Wallis test).…”