Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease,☆☆,,★★

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Abstract

Objective: To assess the role of specific risk factors that may predispose preterm infants with mild or no initial respiratory distress syndrome to the development of chronic lung disease (CLD). Study design: Clinical data were collected prospectively from 119 ventilator- supported preterm infants with birth weights between 500 and 1000 gm, who survived more than 28 days and required fewer than 3 days of treatment with fraction of inspired oxygen >25% during the first 5 days of life. Logistic regression analysis was used in a multivariate assessment of risk factors for CLD. Results: Chronic lung disease occurred in 44 of the patients (37%). The analysis showed that low birth weight, patent ductus arteriosus (PDA), and sepsis were significant risk factors for CLD. The corresponding odds ratios for CLD and their 95% confidence intervals (CI) were as follows: 2.9 per 100 gm birth weight decrement (CI, 1.7 to 4.8); 6.2 (CI, 2.1 to 18.4) for PDA; and 4.4 (CI, 1.3 to 14.5) for sepsis. When sepsis and PDA occurred simultaneously, the odds ratio for CLD increased to 48.3 (CI, 6.3 to >100) in comparison with infants without these conditions. Episodes of PDA were categorized as either early (occurring during the first week of life) or late (after the first week), and the respective odds ratios for CLD were 2.8 (CI, 0.8 to 9.4) and 21.1 (CI, 5.6 to 80) in comparison with infants without PDA. For the duration of symptomatic PDA, the odds ratio for CLD was 3.5 per week that the PDA remained open (CI, 1.9 to 6.5). Conclusion: CLD is a frequent sequela in very low birth weight infants with mild or no respiratory distress syndrome. In this population, the development of late episodes of PDA, usually in association with a nosocomial infection, seems to play a primary role in the pathogenesis of CLD. (J PEDIATR 1995;126:605-10)

Section snippets

METHODS

We prospectively examined all consecutively born preterm infants with birth weights between 500 and 1000 gm who were delivered at the University of Miami/Jackson Memorial Medical Center during a 2-year period beginning in March 1989. Only infants who required mechanical ventilation were included in the study. Infants with symptomatic congenital infections or major congenital anomalies were excluded. Detailed perinatal and neonatal information was abstracted on a daily basis by means of specific

RESULTS

A total of 258 preterm infants with birth weights between 500 and 1000 gm were born at the University of Miami/ Jackson Memorial Medical Center during the 2 years of the study. Of these, 93 infants (36%) died during the first 28 days of postnatal life and were excluded from the analysis. Of the 165 survivors, 46 infants met one of the following exclusion criteria: 16 did not require mechanical ventilation; 28 had severe RDS with high oxygen requirements during the first 5 days of life; 1 had a

DISCUSSION

With the introduction of surfactant therapy and new strategies for mechanical ventilation in infants with RDS, it was anticipated that the incidence of CLD would decrease; however, most clinical trials have failed to confirm this expectation.6, 7, 8 On the contrary, investigators have reported an increasing incidence of CLD in preterm infants with mild or no RDS.3, 4, 9 During the 2-year period of our study, CLD developed in 66 (45%) of 147 surviving ventilator-supported infants with birth

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    From the Department of Pediatrics, Division of Neonatology, University of Miami School of Medicine, Miami, Florida

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    Supported by University of Miami Project: New Born.

    Reprint requests: Eduardo Bancalari, MD, University of Miami School of Medicine, Division of Neonatology, Department of Pediatrics (R-131), PO BOX 016960, Miami, FL 33101.

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    0022-3476/95/$3.00 + 0 9/23/61439

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