Clinical characteristics of chronic lung disease without preceding respiratory distress syndrome in preterm infants.
BACKGROUND
Recently, the incidence of atypical presentation of chronic lung disease (CLD) that develops in infants without a history of preceding respiratory distress syndrome (RDS) is increasing. Therefore, the clinical characteristics of CLD without RDS in comparison with CLD with RDS were assessed.


METHODS
Prospective cohort analysis was done from 117 very low-birthweight infants who were born in Seoul National University Hospital and survived more than 36 weeks postmenstrual age (PMA).


RESULTS
Of the 117 infants analyzed, CLD developed in 44 infants (38%). Among these 44 infants, CLD with RDS developed in 27 infants (23%) and CLD without RDS developed in 17 infants (15%). Each type of CLD was subgrouped according to the presence of chorioamnionitis (CA): RDS(+)CA(+) CLD (n = 8) and RDS(+)CA(-) CLD (n = 19); and RDS(-)CA(+) CLD (n = 12) and RDS(-)CA(-) CLD (n = 5). There were no significant differences in the demographic characteristics between CLD with RDS and CLD without RDS. Chorioamnionitis was significantly more common in CLD without RDS, while patent ductus arteriosus was more common in CLD with RDS. Although the severity of initial respiratory failure was not greater than that of CLD with RDS, CLD without RDS showed a gradually increasing chronic oxygen requirement pattern. Chronic oxygen requirement pattern showed that infants with RDS(+)CA(+)CLD required the highest concentrations of oxygen not only initially but also thereafter until the 28th day of life and 36 weeks PMA.


CONCLUSIONS
Although CLD without RDS was still less common than CLD with RDS, it comprised over a third of all cases of CLD in our study. Clinical characteristics and chronic oxygen requirement pattern of CLD without RDS seems to be less severe than those of CLD with RDS. Our data suggest that CLD without RDS may be developed by causes other than initial acute lung injury. Chorioamnionitis may be one of antecedents of CLD without RDS.
Choi
Chang Won
CW
Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Kim
Beyong Il
BI
Koh
Young Yull
YY
Choi
Jung-Hwan
JH
Choi
Jung Yun
JY
D016022:Case-Control Studies; D002821:Chorioamnionitis / Q000150:complications; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000453:epidemiology; D019102:Infant, Very Low Birth Weight; D008171:Lung Diseases / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D010102:Oxygen Inhalation Therapy; D011247:Pregnancy; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000453:epidemiology