title: Determinants of chronic lung disease severity in the first year of life; A population based study.
abstract: OBJECTIVE
  First, create a clinical severity score for patients with chronic lung disease of infancy (CLDi) following neonatal intensive care unit (NICU) stay. Second, using California wide population-based data, identify factors associated with clinical severity of CLDi at 4-9 months corrected gestational age (CGA).
  
  
  METHODS
  Pediatric pulmonologists ranked and weighted eight factors reflecting clinical severity of CLDi. Utilizing these data we scored and assigned these to 4-9 month old CGA moderate/severe bronchopulmonary dysplasia (BPD) infants, born<30 weeks gestational age (GA), within the California High Risk Infant Follow up (HRIF) program. Infants were studied relative to factors from the California Perinatal Quality Care Collaborative (CPQCC).
  
  
  RESULTS
  We received survey responses from 43/88 pediatric pulmonologists from 28/53 North American training centers who are experts in CLDi. Strong agreement between ranking (72-100%) of respiratory system parameters and weighting (out of 100 points weighting was within 20 points) was observed with severity of CLDi. Data from 940 CLDi premature infants <30 weeks GA were obtained. Infants with severe CLDi scores at 4-9 months CGA (relative to a zero score) showed positive associations with being male, odds ratio[OR] = 2.45[confidence interval (CI) 1.26-4.77]), >30 ventilator days, OR = 3.82 (1.30-11.2), postnatal steroids OR = 3.94 (1.94-7.84), and a surprising inverse association with retinopathy of prematurity stage 3-4, OR = 0.24 (0.09-0.67) CONCLUSIONS: The CLDi clinical severity score allowed for standardized assessment of pulmonary morbidity, and evaluation of risk factors in the NICU for CLDi following NICU discharge. These observations point to risk factors associated with CLDi outcomes at 4-9 months CGA.
authors: Stanford University Department of Pediatrics, California Perinatal Quality Care Collaborative(CPQCC), California High Risk Infant Follow up (HRIF), Stanford, California.
authors: Susan
authors: S
authors: Gage
authors: Stanford University Department of Pediatrics, California Perinatal Quality Care Collaborative(CPQCC), California High Risk Infant Follow up (HRIF), Stanford, California.
authors: Peiyi
authors: P
authors: Kan
authors: Stanford University Department of Pediatrics, California Perinatal Quality Care Collaborative(CPQCC), California High Risk Infant Follow up (HRIF), Stanford, California.
authors: John
authors: J
authors: Oehlert
authors: Stanford University Department of Pediatrics, California Perinatal Quality Care Collaborative(CPQCC), California High Risk Infant Follow up (HRIF), Stanford, California.
authors: Jeffrey B
authors: JB
authors: Gould
authors: Stanford University Department of Pediatrics, California Perinatal Quality Care Collaborative(CPQCC), California High Risk Infant Follow up (HRIF), Stanford, California.
authors: David K
authors: DK
authors: Stevenson
authors: Stanford University Department of Pediatrics, California Perinatal Quality Care Collaborative(CPQCC), California High Risk Infant Follow up (HRIF), Stanford, California.
authors: Gary M
authors: GM
authors: Shaw
authors: Stanford University Department of Pediatrics, California Perinatal Quality Care Collaborative(CPQCC), California High Risk Infant Follow up (HRIF), Stanford, California.
authors: Hugh M
authors: HM
authors: O'Brodovich
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology*; D002908:Chronic Disease / Q000453:epidemiology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008171:Lung Diseases / Q000453:epidemiology*; D008297:Male; D009656:North America / Q000453:epidemiology; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012178:Retinopathy of Prematurity / Q000453:epidemiology; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D005938:Glucocorticoids
keywords: bronchopulmonary dysplasia; chronic lung disease of infancy; premature