Relationship between bronchopulmonary dysplasia, long-term lung function, and vitamin D level at birth in preterm infants

Lu, Tiantian; Liang, Bin; Jia, Yanping; Cai, Jiangyun; Wang, Danhong; Liu, Min; He, Bo; Wang, Qing

doi:10.21037/tp-21-494

Cited by 3 publications

(6 citation statements)

References 19 publications

(21 reference statements)

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“…Moreover, vitamin D deficiency is not the sole risk factor for BPD, and the risk factors and infants included in analysis vary across studies. Consistent with previous findings (10,42,43), we demonstrated that lower gestational age, RDS, and pneumonia were additional risk factors for BPD. Based on these results, we established a nomogram containing cord-blood 25(OH)D level as a factor to predict BPD in VLBW and ELBW preterm infants.…”

Section: Discussionsupporting

confidence: 92%

“…Vitamin D deficiency is very common in VLBW and ELBW preterm infants, especially in northeast China. The incidence of vitamin D deficiency in VLBW and ELBW infants was 84.3% in the present study, and has been reported to range from 37 to 92% in previous studies (8)(9)(10)(11)(12)(13). Fetal and newborn cordblood 25(OH)D concentrations depend on and are correlated with maternal 25(OH)D levels.…”

Section: Discussionsupporting

confidence: 67%

“…Vitamin D participates in cell proliferation, cell differentiation, and the regulation of fetal lung maturation, whereas vitamin D deficiency has been hypothesized to aggravate lung diseases in premature neonates ( 17 , 18 ). The association between vitamin D deficiency and the development of BPD is controversial ( 8 – 10 , 12 , 14 – 16 ). As such, the widespread incidence of vitamin D deficiency may be due to between-study differences in cutoffs for vitamin D deficiency, gestational age, and maternal vitamin D status during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

“…Vitamin D is a sterol hormone, whose active form (and best marker) is 25-hydroxyvitamin D [25(OH)D] (5). Vitamin D deficiency is common both in pregnant women (6,7) and in preterm infants (8)(9)(10)(11)(12)(13). Approximately 37-92% of preterm infants have been reported to suffer from vitamin D deficiency due to their short gestational age and reduced maternal vitamin D supplementation during pregnancy (8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“…Vitamin D deficiency is common both in pregnant women (6,7) and in preterm infants (8)(9)(10)(11)(12)(13). Approximately 37-92% of preterm infants have been reported to suffer from vitamin D deficiency due to their short gestational age and reduced maternal vitamin D supplementation during pregnancy (8)(9)(10)(11)(12)(13). In addition, vitamin D deficiency at birth is associated with poor respiratory outcomes-especially BPDin preterm infants (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

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Utility of umbilical cord blood 25-hydroxyvitamin D levels for predicting bronchopulmonary dysplasia in preterm infants with very low and extremely low birth weight

Fu²,

Feng³

2022

Front. Pediatr.

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Background and objectiveThere remains controversy regarding vitamin D deficiency and bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants. This study aimed to determine the prevalence of vitamin D deficiency assessed by umbilical cord blood 25-hydroxyvitamin D [25(OH)D] in preterm infants in northeast China and to evaluate the ability and optimal threshold of 25(OH)D for predicting BPD.MethodsThe clinical data of VLBW and ELBW preterm infants with known cord-blood 25(OH)D levels were analyzed retrospectively. Infants were divided into groups based on their cord-blood 25(OH)D levels and BPD diagnosis. Logistic regression was performed to assess the risk factors for BPD and a nomogram was established. Receiver operating characteristic (ROC) curve analysis was used to evaluate the optimal threshold of cord-blood 25(OH)D concentration for predicting BPD.ResultsA total of 267 preterm infants were included, of which 225 (84.3%) exhibited vitamin D deficiency and 134 (50.2%) were diagnosed with BPD. The incidence of BPD was lower in the group with a 25(OH)D level of >20 ng/ml than in the other groups (P = 0.024). Infants with BPD had lower cord-blood 25(OH)D levels than those without BPD (11.6 vs. 13.6 ng/ml, P = 0.016). The multivariate logistic regression model revealed that 25(OH)D levels (odds ratio [OR] = 0.933, 95% confidence interval [95% CI]: 0.891–0.977), gestational age (OR = 0.561, 95% CI: 0.425–0.740), respiratory distress syndrome (OR = 2.989, 95% CI: 1.455–6.142), and pneumonia (OR = 2.546, 95% CI: 1.398–4.639) were independent risk factors for BPD. A predictive nomogram containing these four risk factors was established, which had a C-index of 0.814. ROC curve analysis revealed that the optimal cutoff value of 25(OH)D for predicting BPD was 15.7 ng/ml (area under the curve = 0.585, 95% CI: 0.523–0.645, P = 0.016), with a sensitivity of 75.4% and a specificity of 42.9%.ConclusionsA cord-blood 25(OH)D level of <15.7 ng/ml was predictively valuable for the development of BPD. The nomogram established in this study can help pediatricians predict the risk of BPD more effectively and easily.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utility of umbilical cord blood 25-hydroxyvitamin D levels for predicting bronchopulmonary dysplasia in preterm infants with very low and extremely low birth weight

Fu²,

Feng³

2022

Front. Pediatr.

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Early prediction of bronchopulmonary dysplasia: can noninvasive monitoring methods be essential?

Cui

2023

ERJ Open Res

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Despite remarkable breakthroughs in diagnosis and treatment, the prevalence of bronchopulmonary dysplasia (BPD) in preterm infants and the consequent mortality have remained high over the last half-century. The pathophysiology of BPD is complicated, with several causes. In addition, infants with severe BPD are predisposed to a variety of complications that need multidisciplinary collaboration during hospitalisation and post-discharge home treatment. Consequently, early prediction, precise prevention, and individualised management have become the cornerstones of therapeutic care of preterm infants with BPD, thereby improving patient survival and prognosis. BPD has an operational clinical description; however, it has various clinical phenotypes and endotypes, making accurate prediction challenging. Currently, most approaches for predicting BPD in preterm infants include invasive collection of biofluids, which is inappropriate in fragile neonates. Consequently, researchers and clinicians are becoming more interested in noninvasive monitoring for BPD prediction. Comprehensive assessments of pertinent research, however, remain scarce. In this review, we compared many noninvasive monitoring techniques that contribute to early prediction of BPD development in premature infants.

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Development and Validation of a Risk Scoring Tool for Bronchopulmonary Dysplasia in Preterm Infants Based on a Systematic Review and Meta-Analysis

Wang

et al. 2023

Healthcare

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Background: Bronchopulmonary dysplasia (BPD) is the most common serious pulmonary morbidity in preterm infants with high disability and mortality rates. Early identification and treatment of BPD is critical. Objective: This study aimed to develop and validate a risk scoring tool for early identification of preterm infants that are at high-risk for developing BPD. Methods: The derivation cohort was derived from a systematic review and meta-analysis of risk factors for BPD. The statistically significant risk factors with their corresponding odds ratios were utilized to construct a logistic regression risk prediction model. By scoring the weights of each risk factor, a risk scoring tool was established and the risk stratification was divided. External verification was carried out by a validation cohort from China. Results: Approximately 83,034 preterm infants with gestational age < 32 weeks and/or birth weight < 1500 g were screened in this meta-analysis, and the cumulative incidence of BPD was about 30.37%. The nine predictors of this model were Chorioamnionitis, Gestational age, Birth weight, Sex, Small for gestational age, 5 min Apgar score, Delivery room intubation, and Surfactant and Respiratory distress syndrome. Based on the weight of each risk factor, we translated it into a simple clinical scoring tool with a total score ranging from 0 to 64. External validation showed that the tool had good discrimination, the area under the curve was 0.907, and that the Hosmer–Lemeshow test showed a good fit (p = 0.3572). In addition, the results of the calibration curve and decision curve analysis suggested that the tool showed significant conformity and net benefit. When the optimal cut-off value was 25.5, the sensitivity and specificity were 0.897 and 0.873, respectively. The resulting risk scoring tool classified the population of preterm infants into low-risk, low-intermediate, high-intermediate, and high-risk groups. This BPD risk scoring tool is suitable for preterm infants with gestational age < 32 weeks and/or birth weight < 1500 g. Conclusions: An effective risk prediction scoring tool based on a systematic review and meta-analysis was developed and validated. This simple tool may play an important role in establishing a screening strategy for BPD in preterm infants and potentially guide early intervention.

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Relationship between bronchopulmonary dysplasia, long-term lung function, and vitamin D level at birth in preterm infants

Cited by 3 publications

References 19 publications

Utility of umbilical cord blood 25-hydroxyvitamin D levels for predicting bronchopulmonary dysplasia in preterm infants with very low and extremely low birth weight

Utility of umbilical cord blood 25-hydroxyvitamin D levels for predicting bronchopulmonary dysplasia in preterm infants with very low and extremely low birth weight

Early prediction of bronchopulmonary dysplasia: can noninvasive monitoring methods be essential?

Development and Validation of a Risk Scoring Tool for Bronchopulmonary Dysplasia in Preterm Infants Based on a Systematic Review and Meta-Analysis

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