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Antecedents of chronic lung disease following three patterns of early respiratory disease in preterm infants
  1. Matthew Laughon1,
  2. Carl Bose1,
  3. Elizabeth N Allred2,3,4,
  4. T Michael O'Shea5,
  5. Richard A Ehrenkranz6,
  6. Linda J Van Marter7,8,9,
  7. Alan Leviton2,4,
  8. for the ELGAN Study Investigators
  1. 1Division of Neonatal-Perinatal Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
  4. 4Department of Neurology, Children's Hospital, Boston, Massachusetts, USA
  5. 5Division of Neonatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  6. 6Division of Perinatal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  7. 7Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
  8. 8Division of Newborn Medicine, Children's Hospital, Boston, Massachusetts, USA
  9. 9Division of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Matthew Laughon, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC Hospital, CB#7596, 4th floor, Chapel Hill, NC 27599-7596, USA; matt_laughon{at}med.unc.edu

Abstract

Introduction The incidence of chronic lung disease (CLD) varies among groups defined by their early pattern of respiratory disease.

Methods The study examined data collected prospectively on 1204 of the 1506 infants born in 2002–2004 at 23–27 weeks gestation who survived to 36 weeks post-menstrual age. Based on their initial respiratory presentation and need for supplemental oxygen during the first 2 weeks, infants were classified as having early and persistent pulmonary dysfunction (EPPD), early recovery of pulmonary function followed by deterioration (PD) or consistently good pulmonary function characterised by low FiO2 (Low FiO2).

Results CLD was diagnosed in 69% of infants with EPPD, 52% with PD, and 17% in the Low FiO2 group. Birth weight z score <−1 conveyed information about CLD risk in all three groups and was the major risk factor for infants in the Low FiO2 group (OR 27; 95% CI 7 to 95). Mechanical ventilation at 7 days was associated with increased risk in the PD (OR 4.2, 95% CI 2.5 to 6.9) and EPPD groups (OR 2.7, 95% CI 1.5 to 4.7), but not the Low FiO2 group (OR 1.5, 95% CI 0.5 to 3.9).

Conclusion The likelihood of a very preterm infant developing CLD and the profile of risk factors linked with CLD are related to the infant's pattern of respiratory disease during the first 2 postnatal weeks. Among infants with little exposure to oxygen during this period, fetal growth restriction, not mechanical ventilation, is the factor with the strongest association with CLD.

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Footnotes

  • ELGAN Study Investigators Olaf Dammann, Tufts Medical Center, Boston, Massachusetts, USA; Bhavesh L Shah, Baystate Medical Center, Springfield, Massachusetts, USA; Camilia Martin, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Robert Insoft, Brigham and Women's Hospital, Boston, Massachusetts, USA; Karl Kuban, Boston Medical Center, Boston, Massachusetts, USA; Francis Bednarek, U Mass Memorial Health Center, Worcester, Massachusetts, USA; John Fiascone, Tufts Medical Center, Boston, Massachusetts, USA; Richard A Ehrenkranz, Yale University School of Medicine, New Haven, Connecticut, USA; T Michael O'Shea, Wake Forest University/Baptist Medical Center, Winston-Salem, North Carolina, USA; Stephen C Engelke, University Health Systems of Eastern Carolina, Greenville, North Carolina, USA; Carl Bose, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Mariel Poortenga, Ed Beaumont, DeVos Children's Hospital, Grand Rapids, Michigan, USA; Nigel Paneth, Sparrow Hospital, Lansing, Michigan, USA; Michael D Schreiber, University of Chicago Hospital, Chicago, Illinois, USA; Daniel Batton, William Beaumont Hospital, Royal Oak, Michigan, USA; Greg Pavlov, Frontier Science and Technology Research Foundation, Amherst, New York, USA; and our project officer, Deborah Hirtz.

  • Funding This study was supported by a cooperative agreement with NINDS 5U01NS040069-04. CB was supported by the Thrasher Research Fund.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the individual IRBs at participating institutions.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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