New Insights on Early Patterns of Respiratory Disease among Extremely Low Gestational Age Newborns.
BACKGROUND
The analysis of early patterns of lung disease among preterm infants may help to identify predictors of pulmonary deterioration.


OBJECTIVE
To analyze FIO2 requirement in the first 14 days of life among preterm infants and to find predictors of bronchopulmonary dysplasia (BPD).


METHODS
Retrospective cohort study.


METHODS
3 Italian level III NICUs.


METHODS
infants born between 240/7 and 276/7 weeks' gestational age (GA) who survived to 14 days. A consecutive sample of 588 infants was analyzed. Daily mode FIO2 in the first 2 weeks of life were analyzed according to the criteria defined by Laughon et al. [Pediatrics 2009;123:1124-1131], who found 3 early respiratory patterns: consistently low FIO2 (LowFIO2), pulmonary deterioration (PD), and early persistent pulmonary deterioration (EPPD). Factors associated with pulmonary deterioration were studied by univariate and multivariate analysis.


RESULTS
Forty percent of infants had low FIO2, 18% had pulmonary deterioation, 21% had early persistent pulmonary deterioration, and 21% had a previously unreported pattern (pulmonary improvement, PI). The prevalence of BPD was 7% in the LowFIO2 group, 28% in the PI group, 44% in the PD group, and 62% in the EPPD group (p = 0.000). Infants with lung deterioration were more frequently males (OR = 2.019, CI: 1.319-3.090, p = 0.001), had lower GA (OR = 0.945, CI: 0.915-0.975, p = 0.000), higher incidence of severe respiratory distress syndrome (OR = 2.956, CI: 1.430-6.112, p = 0.003), and lack of postnatal caffeine (OR = 0.167, CI: 0.052-0.541, p = 0.003).


CONCLUSIONS
We report 4 distinct patterns of early respiratory disease associated with significantly different prevalence of BPD and discuss risk factors for lung deterioration.
Neonatology Unit, Department of Maternal and Child Health, Salesi Children's Hospital, Marche Polytechnic University, Ancona, Italy.
Stefano
S
Nobile
Paolo
P
Marchionni
Giovanni
G
Vento
Valentina
V
Vendettuoli
Claudio
C
Marabini
Alessandra
A
Lio
Cinzia
C
Ricci
Domenica
D
Mercadante
Mariarosa
M
Colnaghi
Fabio
F
Mosca
Costantino
C
Romagnoli
Virgilio
V
Carnielli
D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008168:Lung / Q000254:growth & development*; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D020127:Recovery of Function; D012119:Respiration; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
Chronic lung disease; Early respiratory disease; Preterm infants