Risk Factors for Chronic Lung Disease in the Surfactant Era: A North Carolina Population-based Study of Very Low Birth Weight Infants

Marshall, Diane D.; Kotelchuck, Milton; Young, Thomas E.; Bose, Carl; Kruyer, L; O’Shea, T. Michael

doi:10.1542/peds.104.6.1345

Cited by 255 publications

(185 citation statements)

References 36 publications

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“…4,7,11,12 However, other observational studies have shown no difference in the early fluid regimens (first 4 to 14 days) of infants who develop BPD 27 or PDA 16,17 compared to those who do not.…”

Section: Discussionmentioning

confidence: 98%

“…Although over-hydration has been implicated in the development of both BPD and PDA, [1][2][3][4][5][6][7][8][9][10][11][12] it is not clear from prior studies whether complications arising from excessive hydration are due to fluid therapy itself, to an increase in total body water resulting from decreased renal losses or an increase in extracellular water volume due to third spacing. 6 To address this question, regression models were run that included weight change in grams per kg of body weight per day.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] It is believed that this becomes increasingly important in extremely low birth weight (ELBW) infants where the margin for error is reduced. Yet precise guidelines for fluid therapy in ELBW infants have not been clearly defined.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,5,6,8,9,11 -18 These recommendations are based on the belief that over-hydration is associated with increased risk for morbidities, including bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA). [1][2][3][4][5][6][7][8][9][10][11][12] However, the evidence supporting fluid restriction is conflicting and inconclusive. Although fluid restriction is a common practice in our neonatal intensive care unit (NICU), it is a practice that differs widely among physician staff, resulting in a large variation in the amount of fluid given to infants.…”

Section: Introductionmentioning

confidence: 99%

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Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants

et al. 2007

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Background: High fluid volumes may increase neonatal morbidity. However, evidence supporting fluid restriction is inconclusive and restricting fluids may restrict caloric intake.Objective: To determine if higher fluid intake was associated with increased risk of patent ductus arteriosus (PDA) or bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants.Study Design: A total of 204 ELBW (p32 weeks, p1250 g) infant survivors were grouped into low-, intermediate-and high-fluid groups. w 2 analyzed proportions of subjects with and without morbidities across groups. Logistic regression quantified increased risk of PDA or BPD associated with fluid intake while controlling for confounders. Analysis of variance compared differences in caloric intake across groups.Result: After controlling for gestational age, severity of illness and weight change, fluid intake on day 2 (odds ratio (OR) 1.014; confidence interval (CI) 1.001 to 1.028) and day 3 (OR 1.022; CI 1.004 to 1.040) was associated with increased risk of PDA.Conclusion: High fluid intake (>170 ml kg À1 day À1 ) in the first days of life is associated with increased risk of PDA.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants

et al. 2007

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“…A PDA is associated with serious neonatal morbidities, including necrotizing enterocolitis (NEC) 1 and chronic lung disease (CLD). 2,3 Although a cause and effect relationship between a PDA and these morbidities has not been established, many neonatologists administer indomethacin prophylactically to prevent intraventricular hemorrhage (IVH), with the additional benefit of reducing the incidence of a symptomatic PDA. 4 Indomethacin treatment is also used beyond the first day of life (DOL) to effect closure of PDAs that are either identified on echocardiogram or by physical examination, particularly those that are associated with signs and symptoms (i.e.…”

Section: Introductionmentioning

confidence: 99%

Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes

2007

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Objective: To describe the current use of treatments to prevent or treat patent ductus arteriosus (PDA) in preterm infants, examine the association between different treatment strategies and neonatal outcomes and review the variation in these practices between centers.Study design: Cohort study of infants born between 23 and 30 weeks gestation managed by the Pediatrix Medical Group from 1997 to 2004. We collected data on demographics, indomethacin and ligation, and outcomes of the following five groups: prophylactic indomethacin treatment: infants treated with indomethacin on day of life (DOL) 0 or 1; indicated indomethacin treatment: infants treated with indomethacin after DOL 1; PDA without treatment: infants with a PDA without report of treatment; ligation only: infants with a PDA ligation without use of indomethacin and no PDA: infants without a PDA and without treatment.Results: There were 6189 (18%) patients who received prophylactic indomethacin, 5690 (16%) patients received indicated treatment, 3886 (11%) patients had a PDA without treatment, 702 (2%) patients received ligation only and 18 136 (52%) patients had no PDA. In multivariate analysis, mortality among survivors to 2 days of age was lower (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.5 to 0.7, P<0.01) and chronic lung disease, isolated intestinal perforation and severe retinopathy of prematurity (stages 3 and 4) were higher (OR 1.5, 95% CI 1.3 to 1.6, P<0.01; OR 1.5, 95% CI 1.1 to 2.0, P<0.01 and 1.4, 95% CI 1.2 to 1.6, P<0.01, respectively) in the indicated treatment group compared with the PDA without treatment group. The proportion of infants receiving prophylactic indomethacin among all infants and infants receiving indicated treatment among neonates with a report of a PDA varied by site from 0 to 59% (median 9.5%) and 0 to 100% (median 62%), respectively.Conclusions: Indomethacin use for intraventricular hemorrhage prevention and/or treatment of a PDA is common, but the selection of infants for treatment, and the decision of when and how to treat vary widely between centers. Our findings suggest the need for randomized, placebo-controlled trials of the effect of treatment of the PDA in preterm infants.

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Late Surfactant Administration in Very Preterm Neonates With Prolonged Respiratory Distress and Pulmonary Outcome at 1 Year of Age

et al. 2016

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IMPORTANCE Although immature neonate survival has improved, there is an increased risk of developing bronchopulmonary dysplasia, leading to significant respiratory morbidity. Measures to reduce bronchopulmonary dysplasia are not always effective or have important adverse effects. OBJECTIVE To evaluate the effect of late surfactant administration in infants with prolonged respiratory distress on ventilation duration, respiratory outcome at 36 weeks' postmenstrual age, and at 1 year postnatal age. DESIGN, SETTING, AND PARTICIPANTS Double-blind randomized clinical trial at 13 level III French perinatal centers. Participants included 118 neonates at less than 33 weeks' gestation who still required mechanical ventilation on day 14 (SD, 2) with fraction of inspired oxygen of more than 0.30. All survivors were eligible for follow-up. We performed an intent-to-treat analysis. INTERVENTIONS Infants received 200 mg/kg of poractant alfa (surfactant) or air after randomization. At 1 year, after parents' interview, infants underwent physical examination by pediatricians not aware of the randomization. MAIN OUTCOMES AND MEASURES The duration of ventilation was the primary outcome. The combined outcome of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age and respiratory morbidity at 1 year of age were the main secondary outcome measures. RESULTS Of the 118 infants who participated in the study, 65 (55%) were male. Fraction of inspired oxygen requirements dropped after surfactant, but not air, for up to 24 hours after instillation (0.36 [0.11] vs 0.43 [0.18]; P < .005). Severe bronchopulmonary dysplasia/death rates at 36 weeks' postmenstrual age were similar (27.1% vs 35.6%; P = .32). Less surfactant-treated infants needed rehospitalization for respiratory problems after discharge (28.3% vs 51.1%; P = .03); 39.5% vs 50% needed respiratory physical therapy (P = .35). No difference was observed for weight (7.8 [1.2] kg vs 7.6 [1.1] kg), height (69 [5] cm vs 69 [3] cm), and head circumference (44.4 [1.7] cm vs 44.2 [1.7] cm) measured at follow-up, nor for neurodevelopment outcome. CONCLUSIONS AND RELEVANCE Late surfactant administration did not alter the early course of bronchopulmonary dysplasia. However, surfactant-treated infants had reduced respiratory morbidity prior to 1 year of age. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01039285

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Risk Factors for Chronic Lung Disease in the Surfactant Era: A North Carolina Population-based Study of Very Low Birth Weight Infants

Abstract: This analysis suggests that with widespread use of surfactant, nosocomial infection, PDA, and water balance persist as risk factors for CLD.

Cited by 255 publications

References 36 publications

Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants

Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants

Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes

Late Surfactant Administration in Very Preterm Neonates With Prolonged Respiratory Distress and Pulmonary Outcome at 1 Year of Age

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