Neonatal risk factors for respiratory morbidity during the first year of life among premature infants.
OBJECTIVE
There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life.


METHODS
Prospective cohort study at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro.


METHODS
Premature infants with birth weight < 1500 g were studied. Lung function tests and high-resolution chest tomography were performed before discharge. During the first year, infants were assessed for respiratory morbidity (obstructive airways, pneumonia or hospitalization). Neonatal lung tests and chest tomography and covariables potentially associated with respiratory morbidity were independently assessed using relative risk (RR). RR was subsequently adjusted via logistic regression.


RESULTS
Ninety-seven newborn infants (mean birth weight: 1113 g; mean gestational age: 28 weeks) were assessed. Lung compliance and lung resistance were abnormal in 40% and 59%. Tomography abnormalities were found in 72%; respiratory morbidity in 53%. Bivariate analysis showed respiratory morbidity associated with: mechanical ventilation, prolonged oxygen use (beyond 28 days), oxygen use at 36 weeks, respiratory distress syndrome, neonatal pneumonia and patent ductus arteriosus. Multivariate analysis gave RR 2.7 (confidence interval: 0.7-10.0) for simultaneous lung compliance and chest tomography abnormalities. Adjusted RR for neonatal pneumonia and mechanical ventilation were greater.


CONCLUSIONS
Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors.
de Mello
Rosane Reis
RR
Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. rosanemello@openlink.com.br
Dutra
Maria Virgínia Peixoto
MV
Ramos
José Roberto
JR
Daltro
Pedro
P
Boechat
Márcia
M
Lopes
José Maria de Andrade
JM
D001938:Brazil / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008173:Lung Diseases, Obstructive / Q000453:epidemiology*; D008297:Male; D011014:Pneumonia / Q000453:epidemiology*; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed