Clinical Correlates of Moderate-to-Severe Bronchopulmonary Dysplasia in Preterm Infants following Surgical Necrotizing Enterocolitis

Abstract

Objective: To determine clinical correlates of moderate to severe bronchopulmonary dysplasia (BPD) in preterm infants following surgical necrotizing enterocolitis (NEC). Methods: A retrospective, single-center cohort study comparing patients with moderate to severe BPD to patients with non/mild BPD among surgical NEC infants. BPD was defined by NIH 2001 consensus definition Results: Of 92 consecutive neonates with surgical NEC, 77% (71/92) had moderate/severe BPD and 22% (21/92) had non/mild BPD. The patent ductus arteriosus (PDA) was significantly higher in those developing moderate/severe BPD (67.6% [48/71]) than non/mild BPD (28.6% [6/21]; p=0.001). Postoperatively,infants with moderate/severe BPD had more severe AKI (67.6% [48/71] vs. 28.6% [6/21]; p=0.001), were intubated longer (40.5 days [IQR 12, 59] vs. 6 days [IQR 2, 13]; p<0.001), received more parenteral nutrition (109 days [IQR 77, 147] vs. 55 days [IQR 19, 70]; p<0.001), developed higher surgical morbidity (46.5% [33/71] vs. 14.3% [3/21]; p=0.008), had more intestinal failure (62.5% vs. 13.3%; p<0.001), required a longer hospital stay (161 days [IQR 112, 186] vs. 64 days [IQR 20, 91]; p<0.001), and were more likely to need home oxygen. In a multivariable analysis, lower birth weight (OR=0.3, [95% CI 0.1-0.5]; p=0.001), patent ductus arteriosus (OR=10.3, [95%CI 1.6-65.4]; p=0.014) and longer parenteral nutritional days (OR=8.8; [95%CI 2.0 -43.0]; p=0.005) were significantly and independently associated with higher odds of moderate/severe vs. non/mild BPD. Conclusion: Development of moderate/severe BPD occurred in the majority of preterm infants with surgical NEC in this consecutive series. Preterm infants with moderate/severe BPD were more likely to have a PDA before NEC. Development of moderate/severe BPD was associated with significantly greater burden and duration of post-operative morbidity following surgical NEC. Identifying surgical NEC infants at increased risk of moderate/severe BPD and developing lung protection strategies may improve surgical NEC outcomes.

Necrotizing Enterocolitis-Associated Acute Kidney Injury—Transforming the Paradigm

“…9 days; p<.001), had longer post-operative days to starting enteral feedings (15 vs. 10 days; p<0.001), had longer days of attainment of full enteral feedings (75 vs. 44 days ; p=0.008), and had longer length of stay (140 vs 94 days; p=0.03) [24]. NEC associated AKI has also been associated with moderate to severe bronchopulmonary dysplasia on the univariate analysis in preterm infants as shown in our recent report [25]. In a study of 109 infants with surgical NEC and SIP [26], infants with >1 surgical complication (43/71, 60.5%) were more likely to have AKI following NEC onset compared to those without any complication.…”

Bronchopulmonary Dysplasia: A Five-Year Retrospective Cohort Study on Differences in Clinical Characteristics and Morbidities According to Severity Grading

“…In our study, the severity of BPD also seemed to be associated with the diagnosis of NEC. Similarly, a study of 92 infants with NEC showed an association between surgical NEC and higher BPD severity [ 29 ].…”

Need for larger cohorts and standardized tools to study diseases in newborn infants

“…Postnatal exposures to developing preterm infants may also be important. In an original study, Garg et al 48 studied retrospectively collected data from a cohort of 62 infants with surgical necrotizing enterocolitis to investigate the clinical determinants and outcomes of cholestasis. Cholestasis was seen more frequently in infants who had developed systemic inflammatory response syndrome and sepsis with positive blood cultures.…”