Fetal Growth Restriction and Chronic Lung Disease Among Infants Born Before the 28th Week of Gestation

Abstract

Objective Improvement in survival of extremely premature infants over the past several decades has resulted in an increase in the number infants with chronic lung disease (CLD). Historical neonatal exposures associated with CLD now less frequently precede the disease. There is now increasing interest in exposures and events before delivery that predict CLD. The objective of this study was to identify current antenatal predictors of CLD. Patients and Methods We collected data about antenatal, placental and neonatal characteristics of 1241 newborns delivered before completion of the 28th week of gestation who were enrolled in a 14-center, observational study conducted during the years 2002-2004. Associations between antenatal factors, microbiologic and histologic characteristics of the placenta, and selected neonatal characteristics and CLD risk were first evaluated in univariate analyses. Subsequent multivariate analyses investigated the contribution of antenatal factors, particularly fetal growth restriction (FGR), to CLD risk. Results Among the antenatal factors, birth weight Z-score, used as a marker of FGR, provided the most information about CLD risk. Indicators of placental inflammation and infection were not associated with increased risk of CLD. Within nearly all strata of antenatal, placental and neonatal variables, growth restricted infants were at increased CLD risk compared with infants who were not growth restricted. FGR was the only maternal or antenatal characteristic that was highly predictive of CLD after adjustment for other risk factors. Conclusions FGR is independently associated with the risk of CLD. Thus factors that control fetal somatic growth may have a significant impact on vulnerability to lung injury, and in this way increase CLD risk. Future investigations should focus on the impact of FGR on growth factors that modulate lung growth.

Maternal preeclampsia and risk of bronchopulmonary dysplasia in preterm infants

“…The literature review found seven similar studies (6)(7)(8)(9)(10)(11)(12). These are summarized in Table 3.…”

“…Of the remaining three studies (6,7,11), all defined BPD as oxygen dependency at 36 wks (one also included X-ray changes) (6), all had high rates of antenatal corticosteroid administration, and all had those alive at 36 wks' PMA as the denominator for the rate of BPD; however, unlike the Victorian data, none were from geographical cohorts. One study selected 371 infants either <32 wks or <1,500 g birth weight from a single center born in the 1990s and found no relationship between PE and BPD at 36 wks (risk ratio 1.03, 95% CI 0.70, 1.52) (11).…”

“…The largest study was of 1,241 infants <28 wks' gestation from 14 centers in the United States. This study excluded 12% of eligible infants for whom parental consent was not obtained (7). In addition, BPD data were not available for 10 subjects; this Pe, preeclampsia.…”

“…Several studies have examined the relationship between intrauterine exposure to maternal PE and the risk of the infant developing BPD (6)(7)(8)(9)(10)(11)(12). Some of these report that PE is protective and reduces the incidence of BPD (9,10,12).…”

“…Some of these report that PE is protective and reduces the incidence of BPD (9,10,12). Others report that PE is associated with an increased incidence of BPD (7,8). Still others have found no change (6,11).…”