Abstract
Background: Classifying the severity of bronchopulmonary dysplasia (BPD) by continuous numerical variables would facilitate follow-up of disease progression and quantified analysis of disease determinants. Objectives: To non-invasively measure oxygenation impairment in BPD by the degree of right-to-left shunt, right shift of the oxyhaemoglobin dissociation curve and ventilation/perfusion (V<sub>A</sub>/Q) inequality and to explore their relation with clinical parameters. Methods: Prospective cohort study of 24 infants with a median (interquartile range, IQR) gestation of 25 weeks (24-27) and a birth weight of 0.70 kg (0.63-0.93), studied at 36 days (30-66), at a postmenstrual age (PMA) of 33 weeks (29-36). Inspired oxygen (F<sub>I</sub>O<sub>2</sub>) was varied to obtain three to five transcutaneous oxygen saturation (SpO<sub>2</sub>) values between 85 and 96%. Values of shunt, shift and V<sub>A</sub>/Q were obtained by plotting the paired data of SpO<sub>2</sub> against F<sub>I</sub>O<sub>2</sub> for each infant using a unique program. Right-to-left shunt, right shift of the oxyhaemoglobin dissociation curve and V<sub>A</sub>/Q were measured in infants born <32 weeks PMA receiving oxygen at 28 days. Results: The median (IQR) shunt was 8% (0.3-16.5), shift 14.5 kPa (10.9-19.4) and V<sub>A</sub>/Q 0.40 (0.30-0.48). Shunt, shift and V<sub>A</sub>/Q were significantly related to gestational age (GA) at birth, PMA at study, weight at study and weight gain per week. Conclusions: Severity of pulmonary oxygenation impairment in BPD can be quantified at the cot-side by non-invasive measurement of shunt, shift and V<sub>A</sub>/Q. Low GA at birth, low weight at birth and at the time of study and impaired weight gain are significantly associated with the severity of oxygen-exchange impairment in infants with BPD.
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