Neonatal respiratory status predicts longitudinal respiratory health outcomes in preterm infants

Abstract

Objectives To examine the relationship between neonatal respiratory status and longitudinal respiratory health outcomes in preterm infants with very low birth weight (VLBW, birth weight <1500 g). Methods A total of 109 VLBW preterm infants were prospectively assessed for respiratory status using the Toce clinical and radiographic scoring method on a postnatal day 28, and severity of bronchopulmonary dysplasia (BPD) at 36‐weeks postmenstrual age (PMA), respiratory morbidity within 1 year of corrected age (CA), pulmonary function test, and six‐minute walk test at 4 years of age. Results A high Toce clinical score on day 28 was associated with the occurrence of respiratory morbidity within 1 year of CA and poor pulmonary function and functional exercise performance at 4 years of age in VLBW preterm infants (all P < 0.05). BPD at 36‐weeks PMA was associated with an increased risk of respiratory morbidity within 1 year of CA and its negative impact on pulmonary function and functional exercise performance at 4 years of age was most pronounced in the severe form (all P < 0.05). Conclusions Early assessments of neonatal respiratory status including Toce clinical score and the severity of BPD are valid to identify VLBW preterm infants who are at risk of adverse longitudinal respiratory health outcomes.

Bronchopulmonary dysplasia from chest radiographs to magnetic resonance imaging and computed tomography: adding value

“…Those without the bubbly/cystic changes had only 2% rate of home oxygen. Bubbly/cystic change is also associated with wheezing [ 32 , 33 ].…”

Modern pulmonary imaging of bronchopulmonary dysplasia

“…Toce et al demonstrated in 1984 that radiological scoring of BPD lung disease on CXR in early premature life has a strong correlation to growth rate, respiratory distress, and clinically-measured gas exchange at 21 days of life (13). More recently, Arai et al found that a cystic/bubbly appearance on postnatal CXR was a potential risk factor of wheezing disorders in 3-year-old children who were born <28 weeks gestation and had a BPD diagnosis (14), and Luo et al demonstrated that high Toce scores on CXR at 28 days of life were associated with poor pulmonary function and exercise performance at 4 years of age in very low birth weight infants (15). With high ease of implementation, relative safety, and modest clinical relevance, CXR is likely to remain the clinical standard for initial radiological evaluation of infants with lung disease in the foreseeable future.…”

Pediatric Pulmonology 2019 year in review: Neonatal pulmonology

“…BPD has long been known to be characterized by airflow limitations and inhomogeneity of ventilation, demonstrated using chest MRI by Yoder et al, 21 and to some extent by Luo et al 22 using the Toce radiographic scoring method. Minimizing the contribution of inadvertent or intrinsic PEEP in ventilator‐dependent BPD patients by adjusting ventilator support improved patient‐ventilator synchrony, as would have been expected 23 .…”