The association between bronchopulmonary dysplasia grade and risks of adverse neurodevelopmental outcomes among preterm infants born at less than 30 weeks of gestation

Oluwole, Izabela; Tan, John B C; DeSouza, Shirin; Hutchinson, Matthew; Leigh, Rebekah M.; Cha, Minha; Rodriguez, Abigail; Hou, Gina; Rao, Srinandini S; Narang, Arvind; Chou, Fu‐Sheng

doi:10.1080/14767058.2023.2167074

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…36,37 School-aged children with severe BPD show lower cognitive, language, academic, executive, emotional, social, physical functioning, and quality of life scores compared with unaffected and moderately affected peers. [38][39][40] All children in our cohort had documented neurodevelopmental delay before and after CNMB, highlighting the vulnerability of this population to ongoing neurodevelopmental insults. When evaluating benefits and burdens of therapies, current and future quality of life considerations should not be undervalued.…”

Section: Discussionmentioning

confidence: 85%

Continuous Neuromuscular Blockade for Bronchopulmonary Dysplasia

Johnson,

Keppel,

McNamara

et al. 2024

Am J Perinatol

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Objective Bronchopulmonary dysplasia (BPD) is the most common late morbidity for premature infants. Continuous neuromuscular blockade (CNMB) is suggested for the most unstable phase of BPD, despite no outcome data. We explored the association between duration of CNMB for severe BPD and mortality. Design Medical record review of children <5 years old admitted from 2016 to 2022 with BPD and one or more course of CNMB for ≥14 days. Results Twelve children received a total of 20 episodes of CNMB for ≥14 days (range 14–173 d) during their hospitalization. Most (10/12) were born at <28 weeks' gestation and most (11/12) with birth weight <1,000 g; 7/12 were of Black race/ethnicity. All were hospitalized since birth. Most (10/12) were initially transferred from an outside neonatal intensive care unit (ICU), typically after a >60-day hospitalization (9/12). Half (6/12) of them had a ≥60-day stay in our neonatal ICU before transferring to our pediatric ICU for, generally, ≥90 days (8/12). The primary study outcome was survival to discharge: 2/12 survived. Both had shorter courses of CNMB (19 and 25 d); only one child who died had a course ≤25 days. Just two infants had increasing length Z-scores during hospitalization; only one infant had a final length Z-score > − 2. Conclusion In this case series of infants with severe BPD, there were no survivors among those receiving ≥25 days of CNMB. Linear growth, an essential growth parameter for infants with BPD, decreased in most patients. These data do not support the use of ≥25 days of CNMB to prevent mortality in infants with severe BPD. Key Points

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Section: Discussionmentioning

confidence: 85%

Continuous Neuromuscular Blockade for Bronchopulmonary Dysplasia

Johnson,

Keppel,

McNamara

et al. 2024

Am J Perinatol

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“…However, we still lack sufficiently powered clinical trials and relevant long-term outcomes in terms of neurodevelopment. Although BPD itself is a disease for life and is associated with poorer neurodevelopmental outcomes, we need neurodevelopmental follow-up data for all survivors to definitely assess if the use of an exclusive human milk diet is warranted for the reduction of relevant outcomes in addition to death and BPD [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Premature delivery invariably results in very different neurodevelopment with effects lasting into adulthood [ 2 ]. Multiple complications such as necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), late-onset sepsis (LOS), and retinopathy of prematurity (ROP), are independently associated with adverse neurological outcomes [ 3 , 4 , 5 , 6 , 7 ]. Preterm infants must adjust to extrauterine life without the caloric and nutritional supply from the placenta.…”

Section: Introductionmentioning

confidence: 99%

Association of Fortification with Human Milk versus Bovine Milk-Based Fortifiers on Short-Term Outcomes in Preterm Infants—A Meta-Analysis

Galis,

Trif,

Mudura

et al. 2024

Nutrients

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This meta-analysis assessed short-term outcomes after using human milk-derived fortifiers (HMFs) compared with bovine milk fortifiers (BMFs) in preterm infants fed an exclusive human milk (HM) diet, either mother’s own milk (MOM) or donor human milk (DHM). We searched PubMed, Embase, Google Scholar, CENTRAL and CINHAL between January 2015 and August 2023 for studies reporting outcomes in infants with ≤28 weeks gestation and/or birthweight ≤ 1500 g on an exclusive human milk diet fortified with HMF versus BMF. The primary outcomes were death and NEC (stage ≥ 2). Four studies with a total of 681 infants were included. Mortality was significantly lower in infants fed with an HM-HMFs diet (four studies, 681 infants; RR = 0.50, 95% CI = 0.26–0.94; p = 0.03; I2 = 0%), NEC was similar between the two groups (four studies, 681 infants; RR = 0.48, 95% CI = 0.20–1.17; p = 0.11; I2= 39%). BPD was higher in the HM-BMFs group (four studies, 663 infants; RR = 0.83, 95% CI = 0.69–1.000; p = 0.05, I2 = 0%), although not statistically significant. No differences were found for sepsis (RR = 0.97, 95% CI = 0.66–1.42; p = 0.96; I2 = 26%) or combined ROP (four studies, 671 infants; RR = 0.64, 95% CI = 0.53–1.07; p = 0.28; I2 = 69%). An HM-HMFs diet could possibly be associated with decreased mortality with no association with NEC, BPD, sepsis, or ROP. This meta-analysis was limited by the small number of studies included. However, the results should not be refuted for this reason as they provide an impetus for subsequent clinical trials to assess the observed associations.

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“…Additionally, comorbid medical conditions such as pulmonary hypertension and other sequelae of prematurity can influence their need for further care. [3][4][5][6][7][8][9] Tracheostomy placement is often considered for children with BPD. 10,11 These patients require prolonged hospitalization and long-term intensive care given their medical complexity.…”

Section: Introductionmentioning

confidence: 99%

Bronchopulmonary Dysplasia and Ventilation-Associated Outcomes After Pediatric Tracheostomy

Johnson,

Beams,

Nadar

et al. 2024

Preprint

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Objectives: To determine the time to ventilator liberation and decannulation after tracheostomy placement in children with bronchopulmonary dysplasia (BPD) and pulmonary hypertension. Methods: A prospective cohort study included all children (<18 years old) who underwent tracheostomy between 2015 and 2021 with or without a diagnosis of BPD. The primary outcome measures were times to mechanical ventilator liberation, tracheostomy decannulation, or death with tracheostomy in place. Patient demographics, associated comorbidities, and outcomes were compared between groups. Results: A total of 318 children met inclusion with a median (interquartile, IQR) age at tracheostomy of 6.9 (IQR: 4.1 – 49.2) months and 54% (N=170) were male. A diagnosis of BPD was made for 43% (N=136) and this group was younger at tracheostomy placement (5.2 vs. 24.5 months, P<.001) and more often had pulmonary hypertension (65% vs. 24%, P<.001) than children without BPD. Children with BPD spent a median of 2.92 years (IQR: 1.60 – 4.03) on mechanical ventilation compared to 1.84 years (IQR: 0.84 – 3.60) for children without BPD ( P=.003). Unadjusted estimation of time to decannulation was longer for children with BPD (HR=0.92, 95% CI: 0.62 – 1.38). The adjusted survival analysis for time to mortality included pulmonary hypertension as a variable of significance (aHR= 2.5, 95% CI: 1.43 – 4.40). Conclusion: The presence of BPD is associated with an increased duration of mechanical ventilation and time to tracheostomy decannulation. Pulmonary hypertension is associated with an increased mortality risk among this vulnerable population of children.

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The association between bronchopulmonary dysplasia grade and risks of adverse neurodevelopmental outcomes among preterm infants born at less than 30 weeks of gestation

Cited by 10 publications

References 23 publications

Continuous Neuromuscular Blockade for Bronchopulmonary Dysplasia

Continuous Neuromuscular Blockade for Bronchopulmonary Dysplasia

Association of Fortification with Human Milk versus Bovine Milk-Based Fortifiers on Short-Term Outcomes in Preterm Infants—A Meta-Analysis

Bronchopulmonary Dysplasia and Ventilation-Associated Outcomes After Pediatric Tracheostomy

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