Prediction of Bronchopulmonary Dysplasia in Preterm Infants Using Postnatal Risk Factors

Abstract

Objective: To identify postnatal risk factors for bronchopulmonary dysplasia (BPD) development in preterm infants with gestational age ≤32 weeks. Methods: Seventy-two preterm infants(30 with BPD and 42 non-BPD controls) admitted in the neonatal intensive care unit (NICU) of the Children's Hospital of Soochow University during 2017 were enrolled in this prospective longitudinal study. Perinatal clinical data, a neonatal critical illness score (NCIS), different soluble B7-H3(sB7-H3), and interleukin-18 (IL-18) levels by days after birth were collected. An early predictive model for BPD development was established based on clinical data using multiple logistic regression analysis. And the sensitivity and specificity of the model were assesed by ROC curve. Results: Electrolyte disturbances, hemodynamically significant patent ductus arteriosus (hs-PDA), and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth were found to be associated with the BPD pathogenesis. Serum sB7-H3, IL-18, and NCIS were significantly higher in the BPD group compared to the non-BPD group (p < 0.05). BPD group had significantly lower enteral fluid and caloric intake compared to the non-BPD group at 1, 7, 14, and 28 days after birth. The risk factors were analyzed by multiple logistic regression and a predictive model of a combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors was evaluated via ROC curve with an area under the curve (AUC) of 0.960 having sensitivity of 86.7% and a specificity of 97.6%, respectively. Conclusion: The causes of BPD are multifactorial postnatal risk factors. And the combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors (electrolyte disturbances, hs-PDA, and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth) might be served as an optimal predictive model for the occurrence of BPD.

Enteral Feeding/Total Fluid Intake Ratio Is Associated With Risk of Bronchopulmonary Dysplasia in Extremely Preterm Infants

“…In the current study, a higher ratio of enteral feeding/total fluid intake during the second week of life was significantly associated with a lower risk of BPD. This finding is consistent with the other two studies ( 18 , 21 ), although the population in our study was younger and smaller. However, Thiess ( 6 ) reported that enteral nutrition supply tended to be higher in the no/mild BPD group but without statistical significance after risk adjustment.…”

Establishment and efficiency analysis of the risk prediction model predicting the likelihood of bronchopulmonary dysplasia in preterm infants: A retrospective observational study

“…Consistent with previous studies [14], the use of invasive ventilation in the BPD group is signi cantly higher compared with that in the non-BPD group. Also, previous research [23] indicated that infants on endotracheal tube for 4-7 days are likely to have BPD or death compared with NIPPV (p < 0.02) and NCPAP (p < 0.01) groups.…”

“…Despite the advanced perinatal and neonatal care, the morbidity and mortality of BPD do not decrease. BPD can affect the survival rate of premature infants and the quality of life of survival of children profoundly and lastingly [14]. Multiple studies showed that preterm infants with BPD continue to have impaired lung function later in the childhood and increased chance of developing asthma [15,16].…”

Development and Validation of a Nomogram for Predicting Bronchopulmonary Dysplasia in Very-Low-Birth-Weight Infants

“…They found that the discrimination accuracies of the method were 0.76, 0.84, and 0.86 on days 4, 7, and 10, respectively. Li Ding et al built a model involving neonatal critical illness score, enteral feeding ≥40 days after birth and other factors ( 25 ). The ROC curve showed a high AUC value of 0,96.…”