148 Intubation Length as A Predictor of Bronchopulmonary Dysplasia

Abstract

Background: Bronchopulmonary dysplasia (BPD) continues to be one of the most common long-term complications associated with preterm birth. Although its pathogenesis is changing, BPD is very often preceded by the use of mechanical ventilation early in life. To date, little information exists on the role of a prolonged intubation in developing lung injury.Methods: Here, we compared the frequency of oxygen-dependency ≥28 days (BPD 28-d) and/or oxygen-dependency ≥36 weeks postmenstrual age + oxygen-dependency ≥28 days (BPD 36 wk) in 121 very low birth weight infants (M:63, F:58, gestational age: 27.4±2.5 weeks, birth weight:. 954±261 g) from our neonatal intensive care unit (NICU), commonly using a minimal intubation approach, to 121 gender and gestational age-matched newborns (M:59, F:62, gestational age: 27.9±2.8, birth weight:. 1005 ± 310 g) from a NICU of comparable size, commonly using a standard intubation policy.Results: A significantly reduced prevalence of BPD-28d (15.7% vs. 29.7%, p=0.014) and BPD-36 wk (0.8% vs. 18.2%, p<0.0001) in the minimal intubation policy population was observed. Minimal intubation policy showed a significantly protective effect on both BPD-28-d (Odds Ratio=0.50; 95% C.I.: 0.26– 0.95; p=0.0034) and BPD-36 wk (O.R.=0.044; 95% C.I.: 0.0058– 0.33; p=0.0025), as compared to the standard intubation strategy. After correction for possible confounding variables, BPD-28d was significantly associated to intubation duration (O.R.=7.06, 95% C.I.: 3.22–15.52, p<0.0001) and Clinical Risk Index for Babies (CRIB)-II score (O.R.=5.22; 95% C.I.: 2.35–11.57, p<0.0001), while BPD-36wk was associated to intubation duration (O.R.=11.03, 95% C.I.: 3.62–33.59, p<0.0001) and gestational age (O.R.=4.61; 95% C.I.: 1.48–14.37, p<0.0083).Conclusion: These findings strongly suggest that a minimal intubation policy may be effective in reducing the BPD risk in VLBW infants, with the potential impact of a shorter intubation length being significantly stronger on BPD-36 wk than BPD-28d.