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Chronic respiratory morbidity following premature delivery--prediction by prolonged respiratory support requirement?
M Kinali1, A Greenough, G Dimitriou
1Children Nationwide Regional Neonatal Intensive Care Centre, King's College Hospital, London, UK.
Insights
Oxygen dependency at 28 days of age is a strong predictor of long-term respiratory issues in infants. This finding helps in diagnosing neonatal chronic lung disease (CLD) earlier and more accurately.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Health
Background:
- Neonatal chronic lung disease (CLD) is typically diagnosed at 36 weeks postconceptional age (PCA) if infants remain oxygen-dependent.
- Early identification of infants at risk for subsequent respiratory morbidity is crucial for timely intervention.
- Current diagnostic criteria for CLD may not fully capture the spectrum of long-term respiratory outcomes.
Purpose of the Study:
- To evaluate if shorter durations of respiratory support in neonates can predict later respiratory morbidity.
- To identify reliable early indicators for diagnosing neonatal chronic lung disease (CLD).
- To assess the relationship between different durations of respiratory support and long-term respiratory symptoms in preterm infants.
Main Methods:
- Prospective follow-up of 103 infants (median gestational age 29 weeks) for 5 years.
- Infants had birth weight < 1500 g or required neonatal ventilatory support.
- Respiratory morbidity was assessed via parental diary cards, defining positive symptom status based on cough/wheeze frequency and relation to upper respiratory tract infections.
Main Results:
- Infants requiring longer respiratory support showed significantly higher rates of subsequent respiratory morbidity (P < 0.05).
- Logistic regression identified oxygen dependency beyond 28 days as the sole independent predictor of later respiratory morbidity (P < 0.01).
- Oxygen dependency at 28 days yielded a positive predictive value of 42% and a likelihood ratio of 2.20 for long-term respiratory symptoms.
Conclusions:
- Oxygen dependency at 28 days of age is a valuable criterion for diagnosing neonatal chronic lung disease (CLD).
- This early marker effectively predicts subsequent respiratory morbidity in high-risk infants.
- The findings support refining diagnostic criteria for CLD to include earlier indicators of respiratory compromise.
Unlabelled:
Neonatal chronic lung disease (CLD) is usually diagnosed if an infant remains oxygen dependent beyond 36 weeks postconceptional age (PCA). Our aim was to determine whether a shorter duration of respiratory support accurately predicted subsequent respiratory morbidity. A total of 103 infants, median gestational age 29 weeks (range 23-35), were followed prospectively for 5 years. They had a birth weight of < 1500 g or, if a birth weight of between 1500 and 2000 g, had required neonatal ventilatory support. Parents completed diary cards; their child had positive symptom status if, in any one year, they coughed and/or wheezed on at least 3 days per week for a 4-week period or for at least 3 days following each upper respiratory tract infection. Subsequent respiratory morbidity, positive symptom status in years 1 and 2 or all 5 pre-school years, was related to various definitions of prolonged respiratory support: intermittent positive pressure ventilation dependence > 7 days; oxygen dependence > 28 days and oxygen dependence > 36 weeks PCA. In years 1 and 2, 25 children were symptomatic and 22 in all 5 years. The patients with subsequent respiratory morbidity were distinguished from those without by requiring longer respiratory support (P < 0.05). Logistic regression analysis demonstrated only oxygen dependence beyond 28 days was independently related to subsequent respiratory morbidity (P < 0.01). The positive predictive values and likelihood ratios (95% confidence intervals) for positive symptom status in all 5 years were for intermittent positive pressure ventilation > 7 days 35% (16-53) and 19.5 (1.01-3.76), for oxygen dependency > 28 days 42% (23-61) and 2.20 (1.45-5.02) and for oxygen dependency >36 weeks PCA 35% (13-58) and 1.67 (0.65-4.31).
Conclusion:
Oxygen dependency at 28 days of age remains a useful criterion on which to diagnose "neonatal" chronic lung disease.