title: Early Cumulative Supplemental Oxygen Predicts Bronchopulmonary Dysplasia in High Risk Extremely Low Gestational Age Newborns.
abstract: OBJECTIVE
  To assess the prognostic accuracy of early cumulative supplemental oxygen (CSO) exposure for prediction of bronchopulmonary dysplasia (BPD) or death, and to evaluate the independent association of CSO with BPD or death.
  
  
  METHODS
  We performed a secondary analysis of the Trial of Late Surfactant, which enrolled 511 infants born at ≤28 weeks gestational age who were mechanically ventilated at 7-14 days of life. Our primary outcome was BPD or death at 36 weeks postmenstrual age, as determined by a physiological oxygen/flow challenge. Average daily supplemental oxygen (fraction of inspired oxygen - 0.21) was calculated. CSO was calculated as the sum of the average daily supplemental oxygen over time periods of interest up to 28 days of age. Area under the receiver operating curve (AUROC) values were generated to evaluate the accuracy of CSO for prediction of BPD or death. The independent relationship between CSO and BPD or death was assessed in multivariate modeling, while adjusting for mean airway pressure.
  
  
  RESULTS
  In the study infants, mean gestational age at birth was 25.2 ± 1.2 weeks and mean birth weight was 700 ± 165 g. The AUROC value for CSO at 14 days was significantly better than that at earlier time points for outcome prediction (OR, 0.70; 95% CI, 0.65-0.74); it did not increase with the addition of later data. In multivariate modeling, a CSO increase of 1 at 14 days increased the odds of BPD or death (OR, 1.7; 95% CI, 1.3-2.2; P < .0001), which corresponds to a 7% higher daily supplemental oxygen value.
  
  
  CONCLUSIONS
  In high-risk extremely low gestational age newborns, the predictive accuracy of CSO plateaus at 14 days. CSO is independently associated with BPD or death. This index may identify infants who could benefit from early intervention to prevent BPD.
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, CA.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Wai
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kohn
authors.affiliation: Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA.
authors.forename: Roberta A
authors.initials: RA
authors.lastname: Ballard
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.
authors.forename: William E
authors.initials: WE
authors.lastname: Truog
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Black
authors.affiliation: Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, CA.
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Asselin
authors.affiliation: Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Ballard
authors.affiliation: Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Rogers
authors.affiliation: Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA. Electronic address: kellerr@ucsf.edu.
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Keller
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D012306:Risk; D015996:Survival Rate
keywords: inhaled nitric oxide; mechanical ventilation; oxidative stress; prematurity; surfactant