184 Is the Severity and Outcome of Respiratory Illness of Preterm Neonates with Generalised, Minimal Subcutaneous Edema Different?

Abstract

Background: Clinical observation suggested that ventilated preterm neonates with generalised minimal edema (GMSE) not amounting to hydrops fetalis, had severe respiratory disease with poor outcomes. Aim: To compare the severity and outcome of the respiratory illness on admission (primary outcome) between ventilated preterm neonates with and without GMSE.The secondary outcomes of interest included non-respiratory outcomes such as IVH and ROP. Design: Case control study in a tertiary neonatal nursery. Methods: Data on all ventilated preterm neonates (gestation<32 weeks)with GMSE (cases) was collected prospectively from 1/1/1999 to 31/12/2000.Two controls mathched for gestational age and sex were selected for each case. Severity of the respiratory illness on admission was assessed by maximum ventilatory-oxygen needs,and need for supplemental oxygen at day 28 and 36 weeks corrected age respectively. Statistics: As Bivariate test procedures, exclusively exact approaches were applied. Fisher's exact tests, linear trend tests and exact non-parametric procedures were used for comparisions between cases and controls. Results: Data on 8 identified cases were compared with 16 controls. Demographic characteristics did not differ significantly in cases vs controls except for the place of birth (outborn:5/8vs2/16, p=0.02). Need for multiple doses of surfactant (Two doses: 50% vs 37.5%,Three doses: 37.5%vs 0%,p=0.005) duration of oxygen supplementation (36(11–51) vs (1–26) days,p=0.036) and postnatal dexamethasone therapy for CLD (2(2–17) vs 0(0–2) days, p=0.007) was significantly more in cases vs controls.There was no significant differences in other variables including the incidences of mild and severe CLD. Conclusion: GMSE in ventilated preterm neonates is associated with significant respiratory illness necessiating multiple doses of surfactant and a longer duration of oxygen and glucocorticoid therapy for CLD.