Prediction of Bronchopulmonary Dysplasia in Preterm Infants Using Postnatal Risk Factors.

Li Ding,Ningxun Cui,Huawei Wang,Fengxia Huang,Haifeng Geng,Xueping Zhu,Xiaoli Zhu

doi:10.3389/fped.2020.00349

Abstract

Objective: To identify postnatal risk factors for bronchopulmonary dysplasia (BPD) development in preterm infants with gestational age ≤32 weeks.Methods: Seventy-two preterm infants(30 with BPD and 42 non-BPD controls) admitted in the neonatal intensive care unit (NICU) of the Children's Hospital of Soochow University during 2017 were enrolled in this prospective longitudinal study. Perinatal clinical data, a neonatal critical illness score (NCIS), different soluble B7-H3(sB7-H3), and interleukin-18 (IL-18) levels by days after birth were collected. An early predictive model for BPD development was established based on clinical data using multiple logistic regression analysis. And the sensitivity and specificity of the model were assesed by ROC curve.Results: Electrolyte disturbances, hemodynamically significant patent ductus arteriosus (hs-PDA), and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth were found to be associated with the BPD pathogenesis. Serum sB7-H3, IL-18, and NCIS were significantly higher in the BPD group compared to the non-BPD group (p < 0.05). BPD group had significantly lower enteral fluid and caloric intake compared to the non-BPD group at 1, 7, 14, and 28 days after birth. The risk factors were analyzed by multiple logistic regression and a predictive model of a combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors was evaluated via ROC curve with an area under the curve (AUC) of 0.960 having sensitivity of 86.7% and a specificity of 97.6%, respectively.Conclusion: The causes of BPD are multifactorial postnatal risk factors. And the combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors (electrolyte disturbances, hs-PDA, and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth) might be served as an optimal predictive model for the occurrence of BPD.

Highlights

Bronchopulmonary dysplasia (BPD) is a chronic lung disease mainly affecting preterm infants who require respiratory support at birth
On days 1, 7, and 14, serum sB7-H3 levels were all higher in the BPD group compared to the non-BPD group, but only levels on day 7 had statistical significance (p < 0.05; Table 4)
The results revealed that the presence of hs-PDA, electrolyte disturbances, and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth was independent risk factors for the development of BPD

Summary

Introduction

Bronchopulmonary dysplasia (BPD) is a chronic lung disease mainly affecting preterm infants who require respiratory support at birth. The detrimental effects of BPD on the respiratory and nervous system could last into adulthood, seriously impacting the well-being of Prediction of Bronchopulmonary Dysplasia in Preterm Infants surviving children [3, 4]. Toll-like receptor 2 (TLR2) signaling is enhanced in hyperoxic fetal lung fibroblasts in vitro. The induction of TLR2 signaling in fetal lung fibroblasts may contribute to the pro-inflammatory state in the preterm neonate on supplemental oxygen [12]. IL-18, a proinflammatory mediator and member of the IL-1 cytokine family, is critical in pulmonary diseases, such as acute respiratory distress syndrome (ARDS) [13] and chronic obstructive lung disease (COPD) [14]. IL-18 may be critical for the occurrence and development of BPD and acts as a possible biomarker for BPD prediction

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Results

Conclusion