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.
Department of Pediatrics, SUNY School of Medicine, Stony Brook, NY 11794-8111, USA. Rita.Verma@sunysb.edu
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Verma
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Chandra
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Niwas
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Komaroff
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