Antecedents of chronic lung disease following three patterns of early respiratory disease in preterm infants

Abstract

OBJECTIVES/INTRODUCTION The incidence of chronic lung disease (CLD) varies among groups defined by their early pattern of respiratory disease. Although CLD is common among infants with continuous exposure to increased ambient oxygen throughout the first two postnatal weeks the antecedents of CLD among preterm infants without this exposure are not well understood. PATIENTS AND METHODS We examined data collected prospectively on the 1204 (out of 1506) infants born in 2002 to 2004 at 23 to 27 completed weeks of gestation who survived to 36 weeks post-menstrual age (PMA). Based on their initial respiratory presentation and need for supplemental oxygen during the first two weeks, infants were classified as having early and persistent pulmonary dysfunction (EPPD), early recovery of pulmonary function followed by deterioration (PD), or consistently good pulmonary function characterized by low FiO2 (Low FiO2). RESULTS CLD was diagnosed in 69% of infants with EPPD, in 52% with PD, and 17% in the Low FiO2 group. Risk factors for CLD varied among these groups. Birth weight z-score < -1 conveyed information about CLD risk in all three groups and was the major risk factor for infants in the Low FiO2 group (Odds Ratio [OR] 27; 95% confidence interval [CI] 7–95). Mechanical ventilation at 7 days was associated with increased risk in the pulmonary deterioration group (OR 4.2, 95% CI 2.5–6.9) and the early and persistent pulmonary dysfunction group (OR 2.7, 95% CI 1.5–4.7), but not the Low FiO2 group (OR 1.5, 95% CI 0.5–3.9). CONCLUSION Both the likelihood of a very preterm infant developing CLD and the profile of risk factors linked with CLD are related to the infant’s pattern of respiratory disease during the first two postnatal weeks. Among infants with little exposure to oxygen during this period, fetal growth restriction, not mechanical ventilation, is the factor with the strongest association with CLD.

Mechanical Ventilation and Bronchopulmonary Dysplasia

“…Although infants with severe neonatal lung disease are more likely to develop severe BPD, it is well known that BPD also afflicts infants who require only minimal respiratory support in the first weeks of life. 13 Exposure to intrauterine inflammation is known to result in Ventilation and Bronchopulmonary Dysplasia accelerated lung maturation in the short term but ultimately triggers biotrauma directly, initiating the cascade of injury and repair that leads to the development of moderate or severe BPD. 14-16…”

Continuous Positive Airway Pressure to Prevent Neonatal Lung Injury: How Did We Get Here, and How Do We Improve?

“…22 Furthermore, clinical data support a relationship between exposure to mechanical ventilation and an increased risk of developing BPD. [23][24][25][26][27][28][29] Therefore, implementing lung protective strategies to avoid the complications of mechanical ventilation might minimize lung injury.…”

Hypoxia–ischemia is not an antecedent of most preterm brain damage: the illusion of validity

“…23 The patterns of associations varied considerably and not necessarily in a cohesive manner. Rather than inferring that the blood gas derangements caused the brain damage, a more plausible interpretation is that the multiple derangements are indicators of immaturity/vulnerability and illness severity.…”