Occurrence and severity of bronchopulmonary dysplasia and respiratory distress syndrome after a preterm birth

Abstract

D espite notable advances in prenatal and neonatal care, respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) remain important complications of preterm births, frequently resulting in mortality as well as short-term and long-term morbidity. BPD, as originally described by Northway et al (1), is less common today, but it has been replaced by a 'new' disease that typically follows mild to moderate RDS in small preterm infants who respond quickly to surfactant therapy but require prolonged ventilation for apnea and poor respiratory efforts (2). The accurate prediction of the development and severity of lung disease in preterm infants could assist clinicians in making critical decisions quickly (3) and could provide a better idea of the short-term prognosis to the treating team and family members. Identifying factors associated with preventing the onset of BPD is also an important facet of neonatology research.The present study of a large cohort of preterm infants had three objectives: to examine factors associated with the development of RDS and BPD, to examine factors associated with BPD severity and to develop a predictive equation for the occurrence of BPD following a preterm birth. Methods subjectsThe study population included all preterm infants (defined as a gestational age of younger than 37 weeks) who were admitted to the Montreal Children's Hospital (Montreal, Quebec) between January 1, 1980, and December 31, 1992. The Montreal Children's Hospital is a tertiary paediatric hospital with a specialized neonatal care department that serves as a referral centre for the province of Quebec. No infants are born at the Montreal Children's Hospital, and all study subjects were transferred to this institution following BACKGRoUNd: Despite notable advances in neonatal care, bronchopulmonary dysplasia (BPD) remains an important complication of preterm birth, frequently resulting in prolonged hospital stay and longterm morbidity. Methods: A historical cohort study of all preterm infants (gestational age younger than 37 weeks) admitted to the Montreal Children's Hospital (Montreal, Quebec) between January 1, 1980, and December 31, 1992, was conducted. Information collected included demographic data, maternal and perinatal history, and main neonatal outcomes. Independent risk factors associated with BPD were identified by univariate analysis using one-way ANOVA, t tests or Mantel-Haenszel c 2 testing. Severity of disease was studied using an ordinal multinomial logistic regression model. ResULts: In total, 1192 preterm infants were admitted, of whom 551 developed respiratory distress syndrome and 322 developed BPD. For each additional week of prematurity, the risk of developing BPD increased by 54% (adjusted OR 1.54/week [95% CI 1.45 to 1.64]). For each point subtracted on the 1 min Apgar score, the risk of developing BPD was increased by 16% (OR 1.16 [95% CI 1.1 to 1.3]). BPD was also associated with the presence of patent ductus arteriosus (OR 3.5 [95% CI 2.1 to 6.0]), pneumothorax in the first 48 h ...

Healthcare utilization and health‐related quality of life of adult survivors of preterm birth complicated by bronchopulmonary dysplasia

“…Hence, an underlying predisposition of male subjects for worse pulmonary outcomes can be hypothesized, especially because it has been demonstrated even in the postsurfactant era that males are at a higher risk of developing BPD in the first place . Male gender has long been known to be a risk factor for prematurity and respiratory complications , and ELBW has been associated with more frequent respiratory complications, so it is interesting to note that despite male infants suffering more frequently from respiratory complications, they were not more likely to be of ELBW. The lower risk of female infants to develop respiratory complications is likely explained by their more mature phospholipid profile during the saccular phase of lung development (between 26 and 36 weeks of gestation), a result of an earlier production of surfactant .…”

Percutaneous closure of patent ductus arteriosus in small infants with significant lung disease may offer faster recovery of respiratory function when compared to surgical ligation

“…In the surgical group, only patients who were on positive pressure ventilation, underwent ligation through a lateral thoracotomy, and were similar to the percutaneous group in matching criteria were included. Patients were matched based on gestational age (GA), BW , weight at time of procedure (WT), and baseline respiratory status (invasive vs. non‐invasive positive pressure respiratory support).…”

Long‐Term Impact of Bronchopulmonary Dysplasia on Pulmonary Function

“…The mean gestational age at discharge was 334.4±117.7 days. Antenatal, and neonatal clinical characteristics associated with BPD severity were reported elsewhere (23). Briefly, among the 322 subjects identified with BPD, the severity of this disease was associated with the following: 1 min Apgar score, gestational age, presence of very low birth weight and the occurrence of neonatal pneumonia/sepsis.…”