Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia

Rocha, Gustavo; Flôr-de-Lima, Filipa; Machado, Ana Paula; Guimarães, Hercília; Proença, Elisa; Carvalho, Cármen; Martins, L. Guedes; Martins, Teresa; Freitas, André Moraes; Dias, C.P.; Silva, Anderson Ricardo Santos da; Barroso, Álvaro Luís; Diogo, I; Cassiano, G.; Ramos, Heloisa; Abrantes, Marta; Costa, Paula Valéria Dias Pena; Salazar, Anabela; Vieira, Filipa; Fontes, Dora; Barroso, Rosalina; Marques, Tânia; Santos, Vagner dos; Scortenschi, Ecaterina; Santos, Cristina Nunes dos; Vilela, Fernanda; Quintas, Conceição

doi:10.3233/npm-180129

Cited by 13 publications

(13 citation statements)

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“…The logistic regression analysis confirmed the findings from the univariate analysis, showing no reliable models for BPD depending on budesonide, but a reliable relationship between death or BPD at 36 weeks PMA and gestational age and SGA condition. This is in accordance with evidence from several studies demonstrating a higher rate of morbidities with lower gestational age, and in particular in the small for gestational age infants 37 …”

Section: Discussionsupporting

confidence: 93%

Intra‐tracheal surfactant/budesonide versus surfactant alone: Comparison of two consecutive cohorts of extremely preterm infants

Moschino

Nardo

Bonadies

et al. 2021

Pediatric Pulmonology

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Objectives To compare the efficacy of intra‐tracheal (IT) surfactant/budesonide (SB) with that of surfactant alone (S) in reducing the rate of bronchopulmonary dysplasia (BPD) at 36 weeks post‐menstrual age (PMA), we included extremely preterm very low birth weight (VLBW) infants with severe respiratory distress syndrome (RDS) in our tertiary neonatal level of care unit (Padua, Italy). Study Design A retrospective chart review of two cohorts of extremely preterm VLBW neonates (<28+0 gestation weeks, birth weight [BW] < 1500 g) born in two consequent epochs (2017–2018/2018–2019) were compared. The SB group received surfactant (200 mg/kg 1st dose) and budesonide (0.25 mg/kg), while the S group received surfactant alone. Results Among 68 neonates with RDS Grades III–IV, FiO2 ≥ 0.3 within 12 h of life, 18 were included in each group after matching for perinatal, clinical, and laboratory characteristics. IT SB did not affect the rate of BPD (Vermont Oxford Network, Jensen's, and National Institute of Child Health and Human Development BPD Workshop 2018 definitions), death, BPD, or death at 36 weeks PMA. Hypotension requiring inotropic support within the first 5 days was lower in those receiving the combined treatment (p = .03). The SB group had fewer admissions to pediatric ward due to respiratory causes up to 12 months of corrected age (p = .03). Conclusion The preliminary results of this retrospective study suggest that in extremely preterm VLBW infants, IT SB for severe RDS did not affect the incidence of BPD, death, and BPD or death at 36 weeks PMA, compared to surfactant alone. The combined therapy proved to be safe in this population. Further studies are warranted to explore the role of early IT steroids on respiratory morbidity in preterm infants.

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Section: Discussionsupporting

confidence: 93%

Intra‐tracheal surfactant/budesonide versus surfactant alone: Comparison of two consecutive cohorts of extremely preterm infants

Moschino

Nardo

Bonadies

et al. 2021

Pediatric Pulmonology

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“…We identified a 3.1-fold higher risk of BPD among SGA preterm infants compared with non-SGA preterm infants, which was in accordance with previous studies that have reported a 2-6-fold higher risk of BPD for SGA preterm infants (3,22,23). A large proportion of SGA preterm…”

Section: Discussionsupporting

confidence: 91%

Neonatal outcome of small for gestational age infants born at 26–33 weeks’ gestation in Chinese neonatal intensive care units

et al. 2021

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Background: Rate and outcomes of small for gestational age (SGA) infants admitted to Chinese neonatal intensive care units (NICU) has been poorly demonstrated. We aimed to describe the rate and outcomes of SGA preterm infants in Chinese NICU, and to evaluate the association of SGA status with neonatal outcomes in different gestational age (GA) and birth weight percentile groups.Methods: This cohort study included all infants born at 26-33 weeks' gestation and admitted to 25 tertiary Chinese NICUs from April 2015 to May 2018. SGA was defined as a birthweight <10th percentile for GA based on the Chinese neonatal birth weight curve.Results: A total of 24,596 infants were included, and 1,867 (7.6%) infants were SGA. SGA infants had significantly higher rates of death or any major morbidity (29.8% vs. 20.5%), mortality (7.0% vs. 4.1%), bronchopulmonary dysplasia (BPD, 17.6% vs. 9.8%), necrotizing enterocolitis (NEC, 4.8% vs. 3.2%) and sepsis (7.3% vs. 4.8%) than non-SGA infants. SGA status was independently associated with increased risk of death or any major morbidity [adjusted odds ratio: 2.37 (2.08-2.71)] as well as increased risks of death, BPD, ROP, death or BPD, death or ROP, NEC and sepsis. The increased risks of adverse outcomes for SGA infants existed across GA groups. The risks of adverse outcomes were highest among infants with a birthweight <3rd percentile.Conclusions: SGA contributes significantly to adverse neonatal outcomes. Specific attentions are warranted when caring for SGA preterm infants.

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“…It may be caused by that we collected the anemia data within 4weeks of life and did not separate into early anemia (less than 2weeks of life) and late anemia (more than 2weeks of life).The association between BPD and anemia and how anemia works on BPD remain to further study. Rocha reported that there existed a signi cant association between SGA and BPD (OR = 5.2 (CI: 1.46-18.58), p = 0.01) by multivariate analysis [32]. The result was different from ours, we can not nd that BPD was associated with SGA.…”

Section: Discussioncontrasting

confidence: 87%

Association Between Blood Gas Within 1week of Life and Bronchopulmonary Dysplasia in Preterm Infants With Less Than 32 Gestational Weeks

Han¹,

Miao²,

Guo³

et al. 2020

Preprint

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Objective: This study tested wether preterm infants of ＜32 gestational weeks (GWs) with a blood gas derangement within 7days of life are at increased risk for moderate and severe bronchopulmonary dysplasia (BPD). Method: 236 preterm infants with ＜32 GWs from January of 2017 to December of 2019 were included in this study. First, univariate analysing determined wether there existed associations between BPD (moderate and severe) and blood gas values, clinical characteristics, interventions, daily given liquid and eneregy within 7days of life. Then multivarariate regession analysis was performed to know wether there were relationships between BPD (moderate and severe) and risk factors between which and BPD (moderate and severe) univariate analysing showed that P value was less than 0.1. Results: From univariate analysing, we found that PaO2, PaCO2 and HCO3 in 7th day of life, cesarean section (OR=0.508, 95%CI:0.275-0.94), getational age (GA, OR=0.163, 95%CI:0.077-0.344), birth weight (BW, OR=0.122, 95%CI:0.054-0.273), PDA (OR=2.839, 95%CI:1.1463-5.508), early onset infection (OR=3.00, 95%CI:1.483-6.069), and mechanical ventilation (MV, OR=4.562, 95%CI:2.405-8.653) were significantly associated with moderate and severe BPD. Because there existed close relationship between GA and BW (R=0.642, P=0.000) and BW dispersion was big in this group, we excluded BW in multivariate analysing. From multivariate analysing, besides GA (Exp (B)=0.176, 95%CI:0.08-0.389) , MV (Exp (B)=3.515, 95%CI:1.746-7.076), PaO2 (Exp (B)=0.468, 95%CI:0.226-0.969) in 7th day of life was the independent risk factor for moderate and severe BPD in the preterm infants of ＜32 GWs.Conclusion: Preterm infants of ＜32GWs with blood gas derangements within 7days of life could be at risk of moderate and severe BPD.

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Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia

Cited by 13 publications

References 50 publications

Intra‐tracheal surfactant/budesonide versus surfactant alone: Comparison of two consecutive cohorts of extremely preterm infants

Intra‐tracheal surfactant/budesonide versus surfactant alone: Comparison of two consecutive cohorts of extremely preterm infants

Neonatal outcome of small for gestational age infants born at 26–33 weeks’ gestation in Chinese neonatal intensive care units

Association Between Blood Gas Within 1week of Life and Bronchopulmonary Dysplasia in Preterm Infants With Less Than 32 Gestational Weeks

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