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Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study

2017; Elsevier BV; Volume: 187; Linguagem: Inglês

10.1016/j.jpeds.2017.04.026

1097-6833

Roberta L. Keller, Rui Feng, Sara B. DeMauro, Thomas W. Ferkol, William D. Hardie, Elizabeth E. Rogers, Timothy P. Stevens, Judith A. Voynow, Scarlett L. Bellamy, Pamela A. Shaw, Paul E. Moore, Barbara D. Alexander, Claire Chougnet, Tari L. Gratton, James M. Greenberg, Cathy Grisby, Alan H. Jobe, Beth Koch, Karen M. McDowell, Kelly Thornton, Pamela Bates, Claudia Cleveland, Aaron Hamvas, Julie Hoffmann, Mark Holland, James S. Kemp, Philip T. Levy, Laura Linneman, Jayne Sicard-Su, Gina Simpson, Gautam K. Singh, Barbara Warner, Philip L. Ballard, Roberta A. Ballard, David J. Durand, Eric C. Eichenwald, Amir Khan, Leslie Lusk, Jeffrey D. Merrill, Dennis W. Nielson, Jeanette Asselin, Samantha Balan, Katrina Burson, Cheryl Chapin, Erna Josiah-Davis, Carmen Garcia, Hart Horneman, Rick Hinojosa, Christopher N. Johnson, Susan Kelley, Karin L. Knowles, M. Layne Lillie, Karen Martin, Sarah K. Martin, Julie Arldt-McAlister, Georgia E. McDavid, Lori Pacello, Shawna Rodgers, Daniel K. Sperry, Judy L. Aschner, Amy B. Beller, Candice D. Fike, Scott O. Guthrie, Tina V. Hartert, Nathalie L. Maitre, Mark O'Hunt, Theresa J. Rogers, Odessa L. Settles, Steven Steele, Marshall Summar, Sharon Wadley, Carl T. D’Angio, Vasanth Kumar, T.J. Mariani, Gloria Pryhuber, Clement L. Ren, Anne Marie Reynolds, Rita M. Ryan, Kristin Scheible, Heidie Huyck, Valerie Lunger, Shannon Castiglione, Aimee Horan, Deanna Maffet, Jane O’Donnell, Michael Sacilowski, Tanya Scalise, Elizabeth Werner, Jason Zayac, Kim Bordeaux, Pam Brown, Julia Epping, Lisa Flattery-Walsh, Donna Germuga, Nancy Piper Jenks, Mary Jane Platt, Eileen Popplewell, Sandra Prentice, Kim Ciccio, C. Michael Cotten, Kim Fisher, Jack Sharp, Charles Clem, Stephanie D. Davis, Susan Gunn, Lauren Jewett, Brenda B. Poindexter, Maria Jose Garcia-Ochoa Blanco, Denise Cifelli, Jonas H. Ellenberg, Melissa Fernando, Howard B. Panitch, Barbara Schmidt, Ann Tierney, Lynn M. Taussig, Carol J. Blaisdell,

Neuroscience of respiration and sleep

Objective To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs). Study design We enrolled ELGANs (<29 weeks' gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks' postmenstrual age. We surveyed caregivers at 3, 6, 9, and 12 months' corrected age to identify postdischarge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheostomy, ventilation), medications, or symptoms (cough/wheeze). Infants were classified as having postprematurity respiratory disease (PRD, the primary study outcome) if respiratory morbidity persisted over ≥2 questionnaires. Infants were classified with severe respiratory morbidity if there were multiple hospitalizations, exposure to systemic steroids or pulmonary vasodilators, home oxygen after 3 months or mechanical ventilation, or symptoms despite inhaled corticosteroids. Mixed-effects models generated with data available at 1 day (perinatal) and 36 weeks' postmenstrual age were assessed for predictive accuracy. Results Of 724 infants (918 ± 234 g, 26.7 ± 1.4 weeks' gestational age) classified for the primary outcome, 68.6% had PRD; 245 of 704 (34.8%) were classified as severe. Male sex, intrauterine growth restriction, maternal smoking, race/ethnicity, intubation at birth, and public insurance were retained in perinatal and 36-week models for both PRD and respiratory morbidity severity. The perinatal model accurately predicted PRD (c-statistic 0.858). Neither the 36-week model nor the addition of bronchopulmonary dysplasia to the perinatal model improved accuracy (0.856, 0.860); c-statistic for BPD alone was 0.907. Conclusion Both bronchopulmonary dysplasia and perinatal clinical data accurately identify ELGANs at risk for persistent and severe respiratory morbidity at 1 year. Trial registration ClinicalTrials.gov: NCT01435187. To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs). We enrolled ELGANs (<29 weeks' gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks' postmenstrual age. We surveyed caregivers at 3, 6, 9, and 12 months' corrected age to identify postdischarge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheostomy, ventilation), medications, or symptoms (cough/wheeze). Infants were classified as having postprematurity respiratory disease (PRD, the primary study outcome) if respiratory morbidity persisted over ≥2 questionnaires. Infants were classified with severe respiratory morbidity if there were multiple hospitalizations, exposure to systemic steroids or pulmonary vasodilators, home oxygen after 3 months or mechanical ventilation, or symptoms despite inhaled corticosteroids. Mixed-effects models generated with data available at 1 day (perinatal) and 36 weeks' postmenstrual age were assessed for predictive accuracy. Of 724 infants (918 ± 234 g, 26.7 ± 1.4 weeks' gestational age) classified for the primary outcome, 68.6% had PRD; 245 of 704 (34.8%) were classified as severe. Male sex, intrauterine growth restriction, maternal smoking, race/ethnicity, intubation at birth, and public insurance were retained in perinatal and 36-week models for both PRD and respiratory morbidity severity. The perinatal model accurately predicted PRD (c-statistic 0.858). Neither the 36-week model nor the addition of bronchopulmonary dysplasia to the perinatal model improved accuracy (0.856, 0.860); c-statistic for BPD alone was 0.907. Both bronchopulmonary dysplasia and perinatal clinical data accurately identify ELGANs at risk for persistent and severe respiratory morbidity at 1 year.