Chronic Oxygen Dependency in Infants Born at Less Than 32 Weeks' Gestation: Incidence and Risk Factors

Abstract

ABSTRACT. Objective. To assess incidence and clinical risk factors of chronic oxygen dependency (COD) among survivors who were born at or before 31 weeks' gestation.Methods. This prospective, multicenter study enrolled 802 infants who were born at or before 31 weeks' gestation and admitted to 8 level III neonatal intensive care units in northern and eastern France from January 1 through December 31, 1997. Need for oxygen to maintain oxygen saturation between 92% and 96% was assessed at 28 days of life and at 36 and 42 weeks' postconceptional age (PCA). Stepwise logistic regression analysis was used to identify the incidence of COD and the risk factors related to its occurrence.Results. The mortality rate was 14%. Antenatal corticotherapy was administered to 51% of patients, surfactant therapy to 76% of the ventilated patients, and highfrequency oscillatory ventilation at day 1 to 32%. At 28 days and 36 and 42 weeks' PCA, respectively, 25%, 15%, and 6% of survivors had COD. After adjustment for intercenter variations, we identified the significant risk factors for COD at these dates: a low gestational age, a high score on the Clinical Risk Index for Infants, intrauterine growth restriction, and surfactant treatment.Conclusion. COD incidence was high at 28 days of life but decreased dramatically by 42 weeks' PCA. This study confirmed previously reported risk factors and underlined the importance of intrauterine growth restriction and the Clinical Risk Index for Infants as significant risk factors. Pediatrics 2001;108(2). URL: http://www. pediatrics.org/cgi/content/full/108/2/e26; bronchopulmonary dysplasia, chronic oxygen dependency.

Site-specific characteristics of infants developing bronchopulmonary dysplasia

“…2 Furthermore, there have been controversies regarding disease definitions and management practices. 3 Some progress has been made in standardizing the definition of BPD, 4 but in spite of this, there continues to be center differences in the rate of BPD. 5 This raises the issue of variation in the management of the sick VLBW in different neonatal intensive care units (NICUs) and the potential impact on BPD.…”

Bronchopulmonary dysplasia in very low birth weight infants is associated with prolonged hospital stay

“…16 Infants at risk for BPD are of major importance because they are substantial in number, have an increased LOS, are at increased risk for additional complications of prematurity and will continue to utilize increased health-care services long after NICU discharge. 4,9 BPD is a common complication of prematurity with a reported incidence of 25 to 42% of VLBW infants 5,17 requiring oxygen therapy at 28 days of age and 12 to 29% at 36 weeks postmenstrual age. [4][5][6]18 The increasing survival of VLBW infants [1][2][3] has resulted in more and smaller infants who develop BPD and require prolonged NICU hospitalization.…”

“…The use of postnatal steroid therapy, although beneficial in decreasing the rate and severity of BPD, 19 has decreased owing to concerns regarding the adverse neurological effects of steroids. The large variation in BPD rates [4][5][6]17,18 may indicate that some therapeutic approaches may decrease the risk of BPD. Possible interventions that could decrease BPD include improved prenatal care and increased use of antenatal Figure 1 Effect of neonatal disease on length of stay of very low birth weight infants with bronchopulmonary dysplasia.…”

Placental Complications and Bronchopulmonary Dysplasia: EPIPAGE-2 Cohort Study

“…5 BPD is strongly associated with low gestational age at birth [6][7][8] and low birth weight for gestational age. [9][10][11][12] Mechanical ventilation, oxygen therapy, patent ductus arteriosus, neonatal infection, male gender, and genetic factors are other risk factors. 10,13,14 Moreover, placentamediated pregnancy complications were recently suggested to be associated with BPD.…”