Article

Bronchopulmonary dysplasia: incidence, risk factors and resource utilization in a population of South American very low birth weight infants.

Departamento de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile.
Jornal de Pediatria (impact factor: 1.01). 82(1):15-20. DOI:10.2223/JPED.1431 pp.15-20
Source: PubMed

ABSTRACT To determine the incidence of bronchopulmonary dysplasia, its risk factors and resource utilization in a large South American population of very low birth weight infants.
Prospectively collected data in infants weighing 500 to 1,500 g born at 16 NEOCOSUR Network centers from 10/2000 through 12/2003. Multivariate relative risk and 95% confidence intervals were estimated by Poisson regression with robust error variance to find factors that affected the risk of bronchopulmonary dysplasia.
1,825 very low birth weight infants survivors were analyzed. Mean birth weight and gestational age were 1085+/-279 g and 29+/-3 weeks respectively. Bronchopulmonary dysplasia incidence averaged 24.4% and survival without bronchopulmonary dysplasia augmented with increasing gestational age. A higher birth weight and gestational age and a female gender all decreased the risk for bronchopulmonary dysplasia. Factors that independently increased that risk were surfactant requirement, mechanical ventilation, airleak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. Bronchopulmonary dysplasia infants had more days of hospitalization (91+/-27 vs. 51+/-19), of mechanical ventilation (19+/-20 vs. 4+/-7) and oxygen therapy (72+/-30 vs. 8+/-14) in comparison with non BPD infants.
Bronchopulmonary dysplasia incidence was 24.4% in a large South American population and is related to greater resource utilization. Risk factors for bronchopulmonary dysplasia in this study were: surfactant requirement, mechanical ventilation, airleak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. These studies may provide useful information in the design of effective preventive perinatal strategies.

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    Article: Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants.
    Pierre Tissières, Patrick Myers, Maurice Beghetti, Michel Berner, Peter C Rimensberger
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    ABSTRACT: Early lung recruitment (ELR) during high-frequency oscillatory ventilation (HFOV) in combination with prophylactic surfactant use has been reported to reduce mortality, improve respiratory outcomes, and reduce the need for repeated surfactant dosing, suggesting that surfactant might be used more selectively in very low birth weight (VLBW) infants on HFOV than generally recommended. We report our first experience from such a selective early rescue use of surfactant in VLBW infants on HFOV. After a deliberate ELR maneuver and "optimal" continuous distending pressure (CDP) finding during HFOV, used as primary ventilation mode for VLBW infants with respiratory distress syndrome (RDS), surfactant was only given when an unsatisfactory oxygenation response to lung recruitment (as defined by CDP x FiO(2) > 5) was observed. Out of 144 VLBW infants on HFOV, 84 (58.3%) received surfactant and 60 (41.7%) did not. Duration of required oxygen supplementation (37.4 +/- 44.9 vs. 46.2 +/- 35.4 days; P = 0.031) and respiratory support (i.e., n-CPAP and/or mechanical ventilation; 22.3 +/- 19.3 vs. 38.2 +/- 24.3 days; P = 0.001) was shorter for infants who did not receive surfactant than for those who did. The incidence and severity of bronchopulmonary dysplasia was similar in both groups, and there was no difference in survival rates between groups. Subgroup analysis for infants of less than 28 weeks of gestation revealed similar results. First intention HFOV combined with an early attempt at lung volume optimization might allow surfactants to be used more selectively (in relation to disease severity) in VLBW infants presenting with RDS at birth without negatively influencing the outcome.
    European Journal of Intensive Care Medicine 03/2010; 36(7):1164-70. · 5.17 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

16 NEOCOSUR Network centers
 
95% confidence intervals
 
bronchopulmonary dysplasia
 
bronchopulmonary dysplasia augmented
 
Bronchopulmonary dysplasia incidence
 
Bronchopulmonary dysplasia infants
 
effective preventive perinatal strategies
 
greater resource utilization
 
higher birth weight
 
large South American population
 
low birth weight infants
 
mechanical ventilation
 
Multivariate relative risk
 
necrotizing enterocolitis
 
non BPD infants
 
oxygen therapy
 
patent ductus arteriosus
 
Poisson regression
 
risk factors
 
robust error variance