Neonatal intermittent hypoxemia events are associated with diagnosis of bronchopulmonary dysplasia at 36 weeks postmenstrual age

Abstract

Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease and major pulmonary complication after premature birth. We have previously shown that increased intermittent hypoxemia (IH) events have been correlated to adverse outcomes and mortality in extremely premature infants. We hypothesize that early IH patterns are associated with the development of BPD. Methods: IH frequency, duration, and nadirs were assessed using oxygen saturation (SpO 2 ) waveforms in a retrospective cohort of 137 extremely premature newborns (<28 weeks gestation). Daily levels of inspired oxygen and mean airway pressure exposures were also recorded. Results: Diagnosis of BPD at 36 weeks postmenstrual age was associated with increased daily IH, longer IH duration, and a higher IH nadir. Significant differences were detected through day 7 to day 26 of life. Infants who developed BPD had lower mean SpO 2 despite their expose to increased inspired oxygen and increased mean airway pressure. Conclusions: BPD was associated with more frequent, longer, and less severe IH events in addition to increased oxygen and pressure exposure within the first 26 days of life. Early IH patterns may contribute to the development of BPD or aid in identification of neonates at high-risk.

The impact of preterm adversity on cardiorespiratory function

“…Di reported that preterm infants with increased oxygen and frequent intermittent hypoxia (IH) events during only the first 3 days of age were commonly on asthma medication at 2 years and total apnoea days were associated with neurodevelopmental impairments (Janvier et al, 2004). Raffay et al (2019) reported an association between frequent, longer and less severe IH events, in addition to oxygen supplementation and respiratory pressure support within the first 26 days of life, and the incidence of bronchopulmonary dysplasia at 36 weeks' postmenstrual age. There is growing evidence to suggest a sex-specific developmental trajectory and thereby sex-dependent responses to treatment and long-term outcomes, with male sex being recognized as a significant factor in poor respiratory outcomes in preterm infants (Farrell & Wood, 1976;Wiswell, Tuggle, & Turner, 1990).…”

“…Raffay et al. () reported an association between frequent, longer and less severe IH events, in addition to oxygen supplementation and respiratory pressure support within the first 26 days of life, and the incidence of bronchopulmonary dysplasia at 36 weeks’ postmenstrual age. There is growing evidence to suggest a sex‐specific developmental trajectory and thereby sex‐dependent responses to treatment and long‐term outcomes, with male sex being recognized as a significant factor in poor respiratory outcomes in preterm infants (Farrell & Wood, ; Wiswell, Tuggle, & Turner, ).…”

The Relationship between Oxidative Stress, Intermittent Hypoxemia, and Hospital Duration in Moderate Preterm Infants

“…It is known that hyperoxia induces free radical injury but there is evidence that desaturation and reoxygenation can contribute to pro-oxidant signaling [10-12]. In extremely preterm infants, intermittent hypoxemia (IH) events are prolific [13] and are associated with multiple adverse outcomes [14-17]. Thus, the potential for IH to induce oxidative stress and reduce antioxidant activation resulting in free radical damage may be a causal pathway in neonatal morbidities.…”

Bronchopulmonary Dysplasia: Crosstalk Between PPARγ, WNT/β-Catenin and TGF-β Pathways; The Potential Therapeutic Role of PPARγ Agonists

“…Relatively short respiratory pauses may precipitate O2 desaturation, bradycardia, and pulmonary hypertension. This can induce retinopathy of prematurity (ROP), sleep disordered breathing, and neurodevelopmental delay (36, 37).…”