Prediction Of Bronchopulmonary Dysplasia Research Articles

Lack of association between early fluid intake and risk of bronchopulmonary dysplasia in extremely low birth weight infants

Objective To evaluate the association between fluid intake during the first 14 days of life and the risk of bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants. Methods A retrospective analysis of a cohort of ELBW admitted in our NICU from 2001 to 2006 compared demographic, clinical data and the daily nutritional intake during the first 14 days of life between the infants with BPD (oxygen at 36 wks pma) and those without BPD. Results Among the 124 infants studied, 22 (17.7%) developed BPD. The mean total fluid intake at 7 days (119±5.3 vs 118.2±8.2 ml/kg/d), at 14 days (136.5±9.1 vs 137.1±8.4 ml/kg/d) and the maximum weight loss (9.0±6.1% vs 10.3±5.2%) were similar in the two groups; BPD infants received higher mean intravenous fluid intake at 14 days (122.9±16.1 vs 109.1±21.8 ml/kg/d). The adjusted risk of higher intravenous fluid intake related to BPD was lost after a multivariate logistic regression analysis that showed GA (OR 0.40; 95% CI 0.30 to 0.52), BW z score (OR 0.47; 95% CI 0.32 to 0.69) and intravenous protein intake at 14 days (OR 0.38; 95% CI 0.18 to 0.80) as the best early independent predictors of BPD. Conclusion In this cohort of ELBW infants early fluid intake was not associated with an increased risk of BPD.

Expression Profiles as Predictors of Bronchopulmonary Dysplasia in Extremely Low Gestational Age Newborns

Restricted accessAbstractFirst published March 2006Expression Profiles as Predictors of Bronchopulmonary Dysplasia in Extremely Low Gestational Age NewbornsJ. Cohen, Y. Sun, […], L. Van Marter, A. Leviton, E. Allred, and I. Kohane+3-3View all authors and affiliationsVolume 54, Issue 2_supplhttps://doi.org/10.1177/108155890605402s88

Increase of interleukin‐6 in tracheal aspirate at birth: A predictor of subsequent bronchopulmonary dysplasia in preterm infants

Abstract Aim: We tested whether interleukin‐6 (IL‐6) in tracheal aspirate (TA) at birth, as a marker of fetal pulmonary inflammation, can be a predictor of bronchopulmonary dysplasia (BPD) in preterm infants. Methods: A total of 75 preterm (≤32 wk) infants who were intubated in the delivery room were prospectively enrolled. Multivariate logistic regression analysis was done to determine whether IL‐6 in TA at birth is an independent risk factor for BPD, and a receiver‐operating characteristic curve was constructed to determine the accuracy of IL‐6 in TA for predicting the risk of BPD. Results: IL‐6 in TA at birth was an independent risk factor for BPD. Fetal pulmonary inflammation defined as IL‐6 in TA at birth ≥316 pg/ml together with patent ductus arteriosus (PDA) additively predicted the risk of BPD. The sensitivity, specificity, and positive and negative predictive values of fetal pulmonary inflammation for the identification of BPD were 73%, 71%, 58% and 83%, respectively. Conclusion: IL‐6 in TA at birth can be used as a predictor of BPD in combination with the presence of PDA.

Increase of interleukin-6 in tracheal aspirate at birth: A predictor of subsequent bronchopulmonary dysplasia in preterm infants

We tested whether interleukin-6 (IL-6) in tracheal aspirate (TA) at birth, as a marker of fetal pulmonary inflammation, can be a predictor of bronchopulmonary dysplasia (BPD) in preterm infants. A total of 75 preterm (< or = 32 wk) infants who were intubated in the delivery room were prospectively enrolled. Multivariate logistic regression analysis was done to determine whether IL-6 in TA at birth is an independent risk factor for BPD, and a receiver-operating characteristic curve was constructed to determine the accuracy of IL-6 in TA for predicting the risk of BPD. IL-6 in TA at birth was an independent risk factor for BPD. Fetal pulmonary inflammation defined as IL-6 in TA at birth > or = 316 pg/ml together with patent ductus arteriosus (PDA) additively predicted the risk of BPD. The sensitivity, specificity, and positive and negative predictive values of fetal pulmonary inflammation for the identification of BPD were 73%, 71%, 58% and 83%, respectively. IL-6 in TA at birth can be used as a predictor of BPD in combination with the presence of PDA.

Early Nasal Continuous Positive Airway Pressure To Minimize The Need for Endotracheal Intubation and Ventilation

After completing this article, readers should be able to: 1. Describe the mechanism by which early nasal continuous positive airway pressure (nCPAP) may reduce bronchopulmonary dysplasia (BPD). 2. List the limited evidence used to confirm the reduction in BPD. 3. List the limited evidence on which to base patient selection for early nCPAP. 4. Explain the uncertainty regarding whether to treat with surfactant replacement. When Northway and associates (1) initially described BPD in 1967, little was known about the injurious effects of ventilation and oxygen. Today, despite the numerous pharmacologic and technical advances in neonatal lung care, BPD remains a cause of serious morbidity in surviving preterm infants. This “new BPD” differs from that originally described by Northway in that it affects predominantly infants born between 24 and 28 weeks’ gestation who have birthweights of less than 1,000 g, many of whom have received antenatal glucocorticoids, minimal “gentle ventilation,” and exogenous surfactant therapy. (2) A variety of factors, including surfactant deficiency, volutrauma, oxygen exposure, antenatal exposure to proinflammatory cytokines, postnatal infection, patent ductus arteriosus, and inadequate postnatal nutrition, are believed to play roles in the pathogenesis of neonatal BPD. The single greatest predictor for BPD appears to be the initiation of mechanical ventilation in the very low-birthweight infant. (3)(4)(5) The introduction of more complex ventilatory strategies, such as high-frequency oscillatory ventilation (HFOV), (6) patient trigger, (7) and volume techniques have not been associated with a reduction in the incidence of BPD in extremely preterm babies. Long-term animal studies demonstrate that HFOV reduces the severity of lung injury but does not prevent the arrest in alveolarization and vascular development that underlies new BPD. (8)(9)(10) This failure may be due to the fact that all respiratory support strategies that involve endotracheal intubation for any length of …

148 Intubation Length as A Predictor of Bronchopulmonary Dysplasia

Background: Bronchopulmonary dysplasia (BPD) continues to be one of the most common long-term complications associated with preterm birth. Although its pathogenesis is changing, BPD is very often preceded by the use of mechanical ventilation early in life. To date, little information exists on the role of a prolonged intubation in developing lung injury.Methods: Here, we compared the frequency of oxygen-dependency ≥28 days (BPD 28-d) and/or oxygen-dependency ≥36 weeks postmenstrual age + oxygen-dependency ≥28 days (BPD 36 wk) in 121 very low birth weight infants (M:63, F:58, gestational age: 27.4±2.5 weeks, birth weight:. 954±261 g) from our neonatal intensive care unit (NICU), commonly using a minimal intubation approach, to 121 gender and gestational age-matched newborns (M:59, F:62, gestational age: 27.9±2.8, birth weight:. 1005 ± 310 g) from a NICU of comparable size, commonly using a standard intubation policy.Results: A significantly reduced prevalence of BPD-28d (15.7% vs. 29.7%, p=0.014) and BPD-36 wk (0.8% vs. 18.2%, p<0.0001) in the minimal intubation policy population was observed. Minimal intubation policy showed a significantly protective effect on both BPD-28-d (Odds Ratio=0.50; 95% C.I.: 0.26– 0.95; p=0.0034) and BPD-36 wk (O.R.=0.044; 95% C.I.: 0.0058– 0.33; p=0.0025), as compared to the standard intubation strategy. After correction for possible confounding variables, BPD-28d was significantly associated to intubation duration (O.R.=7.06, 95% C.I.: 3.22–15.52, p<0.0001) and Clinical Risk Index for Babies (CRIB)-II score (O.R.=5.22; 95% C.I.: 2.35–11.57, p<0.0001), while BPD-36wk was associated to intubation duration (O.R.=11.03, 95% C.I.: 3.62–33.59, p<0.0001) and gestational age (O.R.=4.61; 95% C.I.: 1.48–14.37, p<0.0083).Conclusion: These findings strongly suggest that a minimal intubation policy may be effective in reducing the BPD risk in VLBW infants, with the potential impact of a shorter intubation length being significantly stronger on BPD-36 wk than BPD-28d.

Coagulase-negative staphylococcal sepsis as a predictor of bronchopulmonary dysplasia.

To determine whether sepsis caused by coagulase-negative staphylococci (CoNS) is a risk factor for developing bronchopulmonary dysplasia (BPD) in premature newborns. All newborns born at < or = 30 wk of gestation at Orebro University Hospital during 1994-2001 with clinical sepsis caused by CoNS (group A, n = 22) or by other bacteria (group B, n = 17) were included and compared with premature newborns without sepsis (group C, n = 53). Clinical sepsis was defined as a positive blood culture (monoculture) plus clinical symptoms and laboratory findings. BPD was defined as treatment with oxygen > 21% for at least 28 d. The incidence of BPD differed between the three groups, as follows: CoNS sepsis (A) 64%, other sepsis (B) 41% and control (C) 24%. The difference between the control group and the sepsis groups was highly significant (p = 0.006). In a univariate model the crude estimates of relative risk (RR) for occurrence of BPD increased with presence of sepsis and particularly with presence of sepsis with CoNS (A: RR 2.6, 95% CI 1.5-4.6, p = 0.001; B: RR 1.7, CI 0.8-3.5, p = 0.17). When regression was performed with two additional predictive variables in multivariate models including sepsis, gestational age and mechanical ventilation (group A: RR 1.5, CI 1.1-2.0, p = 0.004; group B: RR 0.9, CI 0.6-1.4, p = 0.67), the estimates were lower. The relative risk for BPD is significantly increased in premature newborns with sepsis caused by CoNS compared with those with sepsis caused by other bacteria and compared with premature newborns with no sepsis.

Coagulase‐negative staphylococcal sepsis as a predictor of bronchopulmonary dysplasia

Aim: To determine whether sepsis caused by coagulase‐negative staphylococci (CoNS) is a risk factor for developing bronchopulmonary dysplasia (BPD) in premature newborns. Methods: All newborns born at ±30 wk of gestation at Örebro University Hospital during 1994–2001 with clinical sepsis caused by CoNS (group A, n= 22) or by other bacteria (group B, n= 17) were included and compared with premature newborns without sepsis (group C, n= 53). Clinical sepsis was defined as a positive blood culture (monoculture) plus clinical symptoms and laboratory findings. BPD was defined as treatment with oxygen &gt;21% for at least 28 d. Results: The incidence of BPD differed between the three groups, as follows: CoNS sepsis (A) 64%, other sepsis (B) 41% and control (C) 24%. The difference between the control group and the sepsis groups was highly significant (p= 0.006). In a univariate model the crude estimates of relative risk (RR) for occurrence of BPD increased with presence of sepsis and particularly with presence of sepsis with CoNS (A: RR 2.6, 95% CI 1.5–4.6, p= 0.001; B: RR 1.7, CI 0.8–3.5, p= 0.17). When regression was performed with two additional predictive variables in multivariate models including sepsis, gestational age and mechanical ventilation (group A: RR 1.5, CI 1.1–2.0, p= 0.004; group B: RR 0.9, CI 0.6–1.4, p= 0.67), the estimates were lower. Conclusion: The relative risk for BPD is significantly increased in premature newborns with sepsis caused by CoNS compared with those with sepsis caused by other bacteria and compared with premature newborns with no sepsis.

Urine Bombesin-Like Peptide as a Predictor for Bronchopulmonary Dysplasia in Infants ≤ 1 kg

Urine Bombesin-Like Peptide as a Predictor for Bronchopulmonary Dysplasia in Infants ≤ 1 kg

Prediction of Bronchopulmonary Dysplasia by Chest Radiographic Scoring System at Seven Days of Age

Prediction of Bronchopulmonary Dysplasia by Chest Radiographic Scoring System at Seven Days of Age

Is surgical ligation of a patent ductus arteriosus the preferred initial approach for the neonate with extremely low birth weight?

The optimal approach to a patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) neonate, whether initial surgical ligation or a trial of indomethacin, has not been established. The authors reviewed the records of 82 ELBW premature infants who had surgical ligation of a PDA during a 2-year period. Thirty-one received indomethacin before ligation. Bronchopulmonary dysplasia (BPD) occurred in 33% of the infants. Predictors of BPD were prolonged positive pressure ventilation, severe intraventricular hemorrhage (IVH) and lower birth weight (BW). Seventy-seven percent of the infants survived. Predictors of mortality were severe IVH, lower BW, and the occurrence of necrotizing enterocolitis (NEC). The indomethacin-treated infants had a lower incidence of NEC and IVH. Overall, 16% of the patients had perioperative morbidity, and 10% of the patients died. The study shows that a trial of indomethacin therapy is not associated with increased complications in ELBW infants with PDA.

Incidence and prediction of bronchopulmonary dysplasia in a cohort of premature infants.

A prospective study on the incidence of bronchopulmonary dysplasia (BPD) in premature infants is reported. A cohort of premature infants with gestational ages < or = 32 weeks, treated during 1989, was followed for one year. Of a total study population of 117 infants, 23 (19.6%) developed BPD, defined as oxygen dependence at 28 postnatal days. However, only 15 infants (12.8%) needed supplementary oxygen at the age of 36 gestational weeks and 5 infants (4.2%) needed supplementary oxygen periodically at one year of age. BPD was found to account for a significant part of both the total and late mortality in the cohort. Measurements of pulmonary mechanics were performed at 3 +/- 1 and 12(13) +/- 1 days of life in a subgroup of 26 infants with RDS who required assisted ventilation for 4 days or longer. No significant difference in lung compliance or resistance could be found during the first examination between infants who later developed BPD and infants with RDS only. At the second examination, infants who later developed BPD had significantly lower lung compliance (0.48 +/- 0.23 ml/cmH2O) than infants in the RDS group (1.50 +/- 0.72 ml/cmH2O) (p < 0.001). Measurements of pulmonary mechanics could be of importance for early prediction of infants at risk of BPD.

Relative likelihood of bronchopulmonary dysplasia based on pulmonary mechanics measured in preterm neonates during the first week of life

We studied 143 low birth weight infants (less than or equal to 1500 gm) with respiratory distress syndrome who required mechanical ventilation, and determined the efficacy of using the alterations in pulmonary mechanics (measured at 1 to 3 days, 4 to 7 days, 2 weeks, and 4 weeks) as possible predictors for the subsequent diagnosis of bronchopulmonary dysplasia (BPD). The sensitivity and specificity of pulmonary compliance and resistance as predictors of BPD were ascertained by logistic regression correlation (p less than 0.01) and receiver operating characteristic curves. With these pulmonary mechanics data and logistic discriminant analysis techniques, we developed BPD prediction models based on pulmonary mechanics, measured between 4 and 7 days of age, to define the likelihood ratio for the subsequent diagnosis of BPD. Eight different BPD prediction models were developed by using combinations of four vectors (pulmonary compliance, total pulmonary resistance, birth weight, gestational age), and each model was validated in a subsequent low birth weight study population (n = 53). All models were deemed accurate for negative prediction of BPD. The models dependent on gestational age and dynamic pulmonary compliance had the highest positive predictive accuracy. The predictive impact of total pulmonary resistance appeared to be minimal. These prediction models may be used to calculate the likelihood ratio for a subsequent BPD diagnosis and thereby objectively categorize both the risk and the magnitude of acute lung injury by the first week of life.