Abstract

BackgroundAerosol administration is increasingly being used as a therapeutic intervention for mechanically ventilated preterm infants. However, the effects of inhalation therapy on retinopathy of prematurity (ROP) have not yet been explored.MethodsA retrospective cohort study was conducted in a tertiary level neonatal intensive care unit (NICU) from 2011 to 2013. All preterm infants with a gestational age (GA) of 24~29 weeks receiving invasive intubation for more than 1 week in the NICU were included. Infants with severe congenital anomalies were excluded. ROP was defined as stage II or greater according to medical records by ophthalmologists. A multivariate logistic regression model was used to estimate the risk of ROP in relation to inhalation therapy after adjusting for confounders.ResultsIn total, 205 infants were enrolled in this study, including 154 with inhalation therapy and 51 without inhalation therapy. Univariate analyses showed an association of inhalation with the following characteristics: sex (p = 0.047), GA (p = 0.029), sepsis (p = 0.047), bronchopulmonary dysplasia (BPD) (p < 0.001), and ROP (p = 0.001). Furthermore, logistic regression analysis indicated that inhalation therapy was an independent risk factor for ROP (odds ratio (OR) = 2.639; 95% confidence interval (CI) = 1.050~6.615). In addition, infants with a GA of 24~25 weeks (OR = 6.063; 95% CI = 2.482~14.81) and 26~27 weeks (OR = 3.825; 95% CI = 1.694~8.638) were at higher risk of ROP than those with a GA of 28~29 weeks. Other factors – including sex, sepsis, BPD, and delivery mode – did not carry significant risk.ConclusionAerosol therapy with pure oxygen delivery is associated with ROP. Clinicians should exercise great caution when conducting aerosol therapy with excess oxygen in mechanically ventilated preterm infants.

Highlights

  • Aerosol inhalation has been widely used to manage pulmonary diseases of children and adults

  • In total, 205 preterm infants were eligible for enrollment, including 54 infants with a gestational age (GA) of 24~25 weeks, 69 infants with a GA of 26~27 weeks, and 82 infants with a GA of 28~29 weeks

  • Drugs used for aerosol therapy included bronchodilators and mucoactive agents

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Summary

Introduction

Aerosol inhalation has been widely used to manage pulmonary diseases of children and adults. Inhalation therapy is increasingly administrated to preterm infants. Several inhalants are used for mechanically ventilated infants, such as bronchodilators, corticosteroids, xanthine derivatives, mucoactive agents, and antibiotics. Yang et al BMC Pulmonary Medicine (2019) 19:145 mucoactive agents in pulmonary critical care for mechanically ventilated preterm infants is not yet clear [11]. Retinopathy of prematurity (ROP) is a common disease of premature infants [12]. Exposing premature infants to supplemental oxygen is an important risk factor for developing ROP [13, 14]. Aerosol administration is increasingly being used as a therapeutic intervention for mechanically ventilated preterm infants. The effects of inhalation therapy on retinopathy of prematurity (ROP) have not yet been explored

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