Abstract
BackgroundThe relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) - a common disease in extremely premature newborn (PTNB) - is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease.AimTo define the duration under MV with greater chance to develop moderate to severe BPD in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and moderate to severe BPD.MethodsFifty-three PTNB were separated into mild and moderate to severe BPD groups and their data were analyzed. Time under MV with a greater chance of developing moderate to severe BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to moderate to severe BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n = 16) by Chi-square test.ResultsTime under MV related to a greater chance of developing moderate to severe BPD was 36 days. Moderate to severe BPD group had more males (14 vs 5, p = 0,047), longer time under MV (43 vs 19 days, p < 0,001), more individuals with PH (12 vs 3, p = 0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p = 0,003), longer hospital length of stay (109 vs 81,5 days, p < 0,001), greater PMA (41 vs 38 weeks, p < 0,001) and weight (2620 vs 2031 g, p < 0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p = 0,043). Among all variables included in logistic regression, only PH and MV < 36 days were significant in the model, explaining 72% of variation in moderate to severe BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the moderate to severe BPD group was 100% (n = 6) and 0% in mild BPD group (p = 0,0001).ConclusionTime under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of moderate to severe BPD.
Highlights
The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) - a common disease in extremely premature newborn (PTNB) - is well stabilished, but is unknown, how much time under MV influences the severity of the disease
Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity
pulmonary hypertension (PH) and time under MV for more than 36 days are related to development of moderate to severe BPD
Summary
The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) - a common disease in extremely premature newborn (PTNB) - is well stabilished, but is unknown, how much time under MV influences the severity of the disease. The 2000 National Heart, Lung and Blood Institute workshop recommends that for preterm infants with gestational age less than 32 weeks, BPD is defined as oxygen exposure for ≥28 days. BPD is a morbidity associated with extreme prematurity, and it has been debated that milder forms of BPD do not seem to have severe consequences, such as serious respiratory morbidity and neurosensory impairment [1, 3] Preterm infants, those born at < 28 weeks of PMA [4], are frequently submitted to MV [5], which despite being a necessary and widely used treatment, has well established adverse effects. The risk of death is 8 times higher in extremely low birth weight preterm infants undergoing MV for more than 6 weeks compared to those exposed only to 7 days or less of invasive ventilation This risk increases to 13 times when isolated only to cardiorespiratory causes [6]. The relationship between invasive mechanical ventilation and the development of the disease is well established, the duration of MV that interferes with severity classification of BPD remains unknown
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
