Bronchopulmonary dysplasia and neurodevelopmental outcome in extremely preterm neonates

Abstract

We tested the hypothesis that the use of supplemental oxygen (sO2) at discharge from the NICU in extremely preterm neonates is associated with a greater risk of neurodevelopmental impairment (NDI) at 18 months corrected gestational age (CGA) than the risk of NDI of those neonates discharged in room air. Four hundred twenty-four charts were retrospectively reviewed from infants born at <27 weeks and transferred to Nationwide Children’s Hospital from December 1, 2004 to June 14, 2010. Use of sO2 was evaluated on day of life (dol) 28, at 36 weeks post-menstrual age (PMA), and at discharge. Logistic regression was used to identify postnatal risk factors associated with sO2 at discharge and NDI. At dol 28, 96 % of surviving patients received sO2, and therefore had bronchopulmonary dysplasia (BPD) by definition from a National Institutes of Child Health and Human Development workshop. At 36 weeks PMA, 89 % continued on sO2 (moderate/severe BPD), and at discharge, 74 % continued on sO2. When factors associated with NDI were examined, the need for mechanical ventilation ≥28 days (adjOR = 3.21, p = 0.01), grade III–IV intraventricular hemorrhage (IVH) (adjOR = 4.61, p < 0.01), and discharge at >43 weeks PMA (adjOR = 2.12, p = 0.04) were the strongest predictors of NDI at 18 months CGA. There was no difference in Bayley Scales of Infant Development, third edition composite scores between patients with no/mild BPD and patients with moderate/severe BPD (cognitive p = 0.60, communication p = 0.53, motor p = 0.19) or those scores between patients on and off oxygen at discharge (cognitive p = 0.58, communication p = 0.70, motor p = 0.62). Conclusions: The need for sO2 at discharge is not associated with an increased risk of NDI in these patients. The strongest predictors of poor neurodevelopmental outcome in this population were prolonged positive pressure support, grade III–IV IVH, and discharge at >43 weeks PMA.

Intratracheal transplantation of mesenchymal stem cells simultaneously attenuates both lung and brain injuries in hyperoxic newborn rats

“…In a multicenter clinical study (1,12), only very-low-birth-weight infants with BPD requiring prolonged oxygen supplementation were at higher risk of poor long-term neurocognitive and academic performance, compared to premature infants exhibiting less severe BPD. These findings suggest that only severe BPD constitutes an independent risk factor for associated brain injury and poor long-term neurodevelopmental outcome in very-lowbirth-weight infants (1,17).…”

“…The use of oxygen is critical for neonatal intensive care, and premature infants are especially vulnerable to oxygen toxicity due to the high possibility of exposure to supra-physiological oxygen concentrations during resuscitation and respiratory management, and a highly immature antioxidant defense mechanism. Besides the well-known toxic effects of hyperoxia on the developing lung, hyperoxia also leads to cell death in the developing white and grey matter of the brain, resulting in motor and cognitive deficits in premature infants (12)(13)(14)(15). In addition to the lung injury known to occur after prolonged exposure to hyperoxia (90% oxygen for 14 d), our data revealed simultaneous hyperoxic brain injury, shown by a retardation in brain weight gain, transiently increased carbonylated protein, reduced MBP, and an increased TUNEL-positive cells and caspase-3 expression, without changes in inflammatory cytokine levels, the number of activated microglia, and superoxide dismutase activity.…”

Increasing F2-isoprostanes in the first month after birth predicts poor respiratory and neurodevelopmental outcomes in very preterm infants

“…Many infants with BPD also subsequently demonstrate significant neurodevelopmental impairments. 1–4 Although some reports imply that the burden of respiratory disease lies in the causative pathway to poor neurodevelopment, 1–3,5–7 a causal relationship remains unproven, and poor neurodevelopmental outcomes can develop in the absence of BPD. 8 …”

Prognosis of Very Preterm Infants with Severe Respiratory Distress Syndrome Receiving Mechanical Ventilation

“…The current study performed on preterm Chinese infants showed HFOV to be associated with significantly lower rates of infant mortality and of BPD, indicating its beneficial effect on premature infants. BPD has been associated with poor neurodevelopmental outcome and was the strongest predictor of poor neurodevelopmental outcome in extremely preterm neonates receiving prolonged positive pressure support and having grade III-IV IVH [18] .…”