Respiratory Outcomes at 12 Months of Corrected Age of Preterm Infants with Severe Bronchopulmonary Dysplasia Requiring Protracted Invasive Ventilation

Sung Hwan Choi; Seung Han Shin; Ee-Kyung Kim; Han-Suk Kim

doi:10.14734/PN.2019.30.1.20

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Choi, Shin, Kim, and Kim: Respiratory Outcomes at 12 Months of Corrected Age of Preterm Infants with Severe Bronchopulmonary Dysplasia Requiring Protracted Invasive Ventilation

Original Article

Perinatology 2019;30(1):20-26.

Published online: 20 March 2019

DOI: https://doi.org/10.14734/PN.2019.30.1.20

Respiratory Outcomes at 12 Months of Corrected Age of Preterm Infants with Severe Bronchopulmonary Dysplasia Requiring Protracted Invasive Ventilation

Sung Hwan Choi, MD, Seung Han Shin, MD, Ee-Kyung Kim, MD, PhD, Han-Suk Kim, MD, PhD

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Correspondence to Seung Han Shin, MD Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-7230 Fax: +82-2-747-5130 E-mail: revival421@snu.ac.kr

Received 15 August 2018 Revised 14 September 2018 Accepted 16 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The objective of this study was to describe respiratory and neurodevelopmental outcomes in infants with severe bronchopulmonary dysplasia (BPD) who needed invasive ventilation until 36 weeks' postmenstrual age (PMA).

Methods

A retrospective observational single-center study was conducted in our hospital. Eighty preterm infants born between January 2007 and December 2016 with less than 28 weeks' gestational age and classified as having severe BPD were included in the study. Patients with invasive ventilation at 36 weeks' PMA (invasive group) were compared with those with noninvasive ventilation (noninvasive group) in terms of perinatal characteristics and postnatal outcomes.

Results

Antenatal characteristics and basic patient characteristics were comparable between the two groups. Incidence of pulmonary hemorrhage (13.6 vs. 1.7%, P=0.061) and clinical sepsis (66.7 vs. 31.0%, P=0.004) was more in the invasive group. Invasive group had longer hospital stay (133.50± 104.52 vs. 114.00±24.71 days, P=0.031), higher rates of readmission due to respiratory problems before 12 months of corrected age (57.1 vs. 32.1%, P=0.045), higher rates of having a tracheostomy (22.7 vs. 1.7%, P=0.005), and higher rates of infants with respiratory support at a corrected age of 6 months (22.7 vs. 3.5%, P=0.016). Neurodevelopmental outcomes including Bayley Scales of Infant Development-III, cerebral palsy, hearing aid, blindness, and composite outcome of them revealed no differences between the two groups.

Conclusion

Invasive ventilation until postmenstrual age of 36 weeks does not predict poorer neuro-developmental outcomes in infants with severe BPD. However, the invasive group was more prone to develop respiratory problems after discharge.

Keywords: Preterm infants, Bronchopulmonary dysplasia, Respiration, Artificial, Growth and Development, Lung injury

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Fig. 1.

Flow diagram of the preterm infants involved in the study. GA, gestational age; BPD, bronchopulmonary dysplasia; PMA, postmenstrual age.

Fig. 2.

Duration of invasive ventilation.

Table 1.

Antenatal Characteristic of the Study Population

Characteristic	Invasive (n=22)	Noninvasive (n=58)	P-value
Maternal age (years)	) 32.50±3.25	33.00±5.80	0.260
Preeclampsia	2 (9.1)	4 (6.9)	0.665
PROM	13 (59.1)	38 (65.5)	0.593
PROM duration∗ (da	ays) 14.00±12.00	11.00±18.17	0.823
Prenatal antibiotics	18 (85.7)	44 (75.9)	0.537
Chorioamnionitis	12 (54.5)	34 (58.6)	0.742
Oligohydramnios	6 (27.3)	15 (26.3)	0.931
GDM	0 (0.0)	3 (5.2)	0.557
Antenatal steroid	14 (63.6)	40 (69.0)	0.650
Cesarean section	10 (45.5)	36 (62.1)	0.180
Multiple births	13 (59.1)	32 (55.2)	0.752

Values are presented as mean±standard deviation or number (%). Abbreviations: PROM, preterm premature rupture of membrane; GDM, gestationa diabetes mellitus. ∗The time interval between PROM and delivery.

Table 2.

Characteristics of Study Population

Characteristic	Invasive (n=22)	Noninvasive (n=58)	P-value
Gestational age (days) 1	178.50±8.93	179.00±9.83	0.752
Body weight (g)	740±166.25	765±168.71	0.551
Male sex	15 (68.2)	31 (53.4)	0.234
Body weight at birth (Z-score)	0.01±0.93	–0.10±0.86	0.982
Length at birth (Z-score)	0.00±1.07	–0.06±0.99	0.243
Head circumference at birth (Z-score)	–0.18±0.79	–0.23±1.41	0.707
Small for gestational age	5 (22.7)	7 (12.1)	0.295
Apgar score at 1 minute	2.50±1.85	3.00±1.71	0.721
Apgar score at 5 minutes	4.50±1.79	5.00±1.93	0.237
Respiratory distress syndrome	20 (90.9)	49 (84.5)	0.718
Pulmonary hemorrhage	3 (13.6)	1 (1.7)	0.061
Air leak	3 (13.6)	3 (5.4)	0.342
Systemic dexamethasone use	13 (61.9)	12 (21.4)	0.001
Total dexamethasone dose∗ (mg/kg)	1.26±0.72	0.98±0.56	0.320
PDA requiring treatment	20 (90.9)	48 (82.8)	0.495
Presence of bacteria from LRT	20 (90.9)	55 (94.8)	0.612
Clinical sepsis	14 (66.7)	18 (31.0)	0.004
Proven sepsis	11 (52.4)	13 (22.4)	0.011
IVH grade ≥3	2 (9.1)	11 (19.0)	0.498
Periventricular leukomalacia	3 (14.3)	7 (12.1)	0.721
NEC grade ≥2A	6 (27.3)	8 (13.8)	0.192

Values are presented as mean±standard deviation or number (%). Abbreviations: PDA, patent ductus arteriosus; LRT, lower respiratory tract; IVH, intraventricular hemorrhage; NEC, necrotizing enterocolitis. ∗Total dose of systemic dexamethasone for the treatment of BPD divided by the body weight at the time of dexamethasone administration.

Table 3.

Postneonatal Outcomes and Growth of Study Population

Postneonatal outcome	Invasive (n=22)	Noninvasive (n=58)	P-value
Duration of admission (days)	133.50±104.52	114.00±24.71	0.031
Duration of invasive ventilation (days)	83.94±16.07	52.04±16.26	0.000
Respiratory support at discharge	15 (71.4)	35 (60.3)	0.367
Tracheostomy	5 (22.7)	1 (1.7)	0.005
Readmission due to respiratory	12 (57.1)	18 (32.1)	0.045
problems before CA 12 months
Respiratory support at CA 6 months	5 (22.7)	2 (3.5)	0.016
Death after PMA 36 weeks	1 (2.5)	1 (1.7)	0.477
Body weight at PMA 36 weeks (Z-score	e) −1.23±0.89	–1.83±0.67	0.030
Length at PMA 36 weeks (Z-score)	–2.12±1.08	–2.49±0.70	0.363
Head circumference at PMA 36 weeks	–2.01±0.94	–2.44±0.91	0.095
(Z-score)
Body weight at CA 12 months (Z-score	e) −0.58±1.57	–0.63±1.45	0.325
Length at CA 12 months (Z-score)	–0.07±1.94	–0.52±1.30	0.566
Head circumference at CA 12 months	–0.88±2.83	–1.27±1.41	0.785
(Z-score)

Values are presented as mean±standard deviation or number (%).

Table 4.

Neurodevelopmental Outcomes of Study Population

Neurodevelopmental In outcome	nvasive (n=22) N	Noninvasive (n=58)	P-value
Cerebral palsy	1 (5.0)	5 (8.9)	1.000
Hearing aid	1 (5.0)	2 (3.5)	1.000
Blindness	0 (0.0)	0 (0.0)	–
BSID-III composite score
Cognition (CA 8 months)	82.50±15.35	91.74±11.44	0.052
Language (CA 8 months)	86.50±17.36	89.21±6.71	0.721
Motor (CA 8 months)	81.17±21.59	89.84±13.85	0.206
Cognition (CA 18 months)	87.22±11.48	88.55±14.56	0.803
Language (CA 18 months)	78.44±8.86	87.17±15.25	0.112
Motor (CA 18 months)	84.44±18.71	84.97±15.06	0.932
BSID-III score <70
Cognition (CA 8 months)	1 (12.5)	1 (2.3)	0.292
Language (CA 8 months)	1 (16.7)	0 (0.0)	0.176
Motor (CA 8 months)	2 (33.3)	1 (3.1)	0.059
Cognition (CA 18 months)	1 (20.0)	4 (12.9)	1.000
Language (CA 18 months)	1 (11.1)	4 (13.3)	1.000
Motor (CA 18 months)	2 (22.2)	4 (13.3)	0.607
NDI at CA 18 months∗	2 (18.2)	10 (28.6)	0.701

Values are presented as mean±standard deviation or number (%). Abbreviations: CA, corrected age; BSID-III, Bayley Scales of Infant Development third edition. ∗Cerebral palsy or hearing aid or blindness or any BSID-III score less than 70.

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