Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants.
OBJECTIVE
We studied the ante- and postnatal risk factors and clinical outcomes associated with pulmonary interstitial emphysema (PIE) in extremely low birth weight infants (ELBW, <1000 g at birth) in the present era of tocolytics, antenatal steroid and postnatal surfactant administration.


METHODS
This was a retrospective case-controlled study of all ELBW admitted consecutively during a designated study-period in a level III nursery. Data were analyzed by performing univariate and multivariate analysis as applicable.


RESULTS
Infants with PIE had lower 1 and 5 min Apgar scores (P=0.04 and 0.003 respectively), increased surfactant utilization (P=0.004), higher maximum inspired oxygen concentration (P=0.04) and mean airway pressure administration (P=0.02) during the first week of life, and increased neonatal mortality (P=0.01). They received higher antenatal doses of magnesium sulfate (MgSO(4)) (P=0.02). 56% of infants with PIE were exposed to more than 10 g of MgSO(4) (Mg10), compared to 15% in non-PIE group (P=0.01). The multivariate logistic regression analysis including significant co-variates revealed an independent association between Mg10 and PIE (P=0.01, Odds ratio 19.8, 95% CI 1.5-263).


CONCLUSIONS
Pulmonary interstitial emphysema is associated with increased mortality in ELBW infants. Mg10 is an independent risk factor for PIE in this population.
Verma
R P
RP
Department of Pediatrics, SUNY School of Medicine, Stony Brook, NY 11794-8111, USA. Rita.Verma@sunysb.edu
Chandra
S
S
Niwas
R
R
Komaroff
E
E
D001034:Apgar Score; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D010100:Oxygen / Q000627:therapeutic use; D011336:Probability; D011656:Pulmonary Emphysema / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D012121:Respiration, Artificial / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
D010100:Oxygen