Regional Variation on Rates of Bronchopulmonary Dysplasia and Associated Risk Factors

Abstract

Background. An abnormally high incidence (44%) of bronchopulmonary dysplasia with variations in rates among cities was observed in Colombia among premature infants. Objective. To identify risk factors that could explain the observed high incidence and regional variations of bronchopulmonary dysplasia. Study Design. A case-control study was designed for testing the hypothesis that differences in the disease rates were not explained by differences in city-of-birth specific population characteristics or by differences in respiratory management practices in the first 7 days of life, among cities. Results. Multivariate analysis showed that premature rupture of membranes, exposure to mechanical ventilation after received nasal CPAP, no surfactant exposure, use of rescue surfactant (instead of early surfactant), PDA, sepsis and the median daily FIO2, were associated with a higher risk of dysplasia. Significant differences between cases and controls were found among cities. Models exploring for associations between city of birth and dysplasia showed that being born in the highest altitude city (Bogotá) was associated with a higher risk of dysplasia (OR 1.82 95% CI 1.31–2.53). Conclusions. Bronchopulmonary dysplasia was manly explained by traditional risk factors. Findings suggest that altitude may play an important role in the development of this disease. Prenatal steroids did not appear to be protective at high altitude.

Epidemiology of bronchopulmonary dysplasia

“…At 17 NICHD Neonatal Research Network centers, rates of BPD based on the physiologic definition ranged from <10% to >50% in infants with birth weights less than 1250 g (Walsh et al, ). Similar variability is seen across Vermont Oxford Network centers and internationally (Payne et al, , b; Zeitlin et al, ; Choi et al, ; Rojas et al, ). In 10 European regions, rates of BPD ranged between 10.5% and 21.5% for infants born less than 32 weeks gestation in 2003 (Zeitlin et al, ).…”

Association of Chorioamnionitis With Bronchopulmonary Dysplasia Among Preterm Infants

“…84 Nine studies defined CA using a microbiological definition. 28,29,47,53,58,64,131,135,152 Finally, 16 studies 102,104,105,108,113,120,123,128,129,130,139,141,148,155,160,170 did not define CA and, for the purposes of analysis, were considered to evaluate clinical CA.…”

Alterações do fluxo sanguíneo em artéria umbilical na síndrome hipertensiva gestacional e suas implicações nos resultados neonatais

“…No entanto, a presença de DZ ou DR está intimamente ligada a RN pré-termos e baixo peso que, independente da presença dessas alterações na doplervelocimetria, já são mais susceptíveis a ventilação mecânica prolongada e, consequentemente, maior risco de displasia broncopulmonar. Essa associação está bem definida em literatura: quanto menor o RN maior o risco de lesão pulmonar 18,19 .…”