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Chronic lung disease in extremely low birth weight infants: a two-year retrospective analysis
1Department of Pediatrics, China Medical College Hospital, Taichung, Taiwan.
Insights
This study analyzed chronic lung disease (CLD) in extremely low birth weight (ELBW) infants, finding over half of survivors developed CLD. Bronchopulmonary dysplasia (BPD) and Wilson-Mikity syndrome (WMS) showed higher morbidity than chronic pulmonary insufficiency of prematurity (CPIP).
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Extremely low birth weight (ELBW) infants face significant risks of respiratory complications.
- Chronic lung disease (CLD) is a common, yet complex, condition in premature infants.
- Understanding CLD subtypes is crucial for targeted interventions and improved outcomes.
Purpose of the Study:
- To determine the incidence and classification of chronic lung disease (CLD) in extremely low birth weight (ELBW) infants.
- To compare the clinical characteristics and outcomes of different CLD classifications.
- To inform strategies for preventing and managing CLD in this vulnerable population.
Main Methods:
- A 2-year retrospective analysis of 117 infants weighing less than 1000 g.
- CLD defined by supplemental oxygen requirement at 28 days, persistent respiratory distress, and characteristic chest radiograph findings.
- Classification into bronchopulmonary dysplasia (BPD), Wilson-Mikity syndrome (WMS), and chronic pulmonary insufficiency of prematurity (CPIP) based on clinical and radiographic features.
Main Results:
- The overall survival rate beyond 28 days was 60.7% (71/117).
- CLD incidence among survivors was 50.7% (36/71), with BPD in 47%, WMS in 11%, and CPIP in 42%.
- BPD and WMS groups required significantly longer mechanical ventilation and oxygen support, with higher rates of persistent oxygen dependence at 36 weeks post-conception compared to CPIP.
Conclusions:
- Chronic lung disease in ELBW infants encompasses a spectrum of conditions with varying severity.
- Bronchopulmonary dysplasia and Wilson-Mikity syndrome present with greater respiratory morbidity and mortality.
- Further research into preventative strategies for CLD in ELBW infants is warranted.
Abstract:
To determine the incidence and classification of chronic lung disease (CLD) in extremely low birth weight (ELBW) infants, a 2-year retrospective analysis was performed. From January 1997 to December 1998, 117 infants weighing less than 1000 g were enrolled. The survival rate beyond 28 days was 60.7% (71/117). CLD was defined as a supplemental oxygen requirement at 28 days of age, with symptoms of persistent respiratory distress and chest radiograph showing characteristic appearance. In addition to the common finding of CLD, infants with bronchopulmonary dysplasia (BPD) had history of respiratory distress syndrome (RDS), infants with Wilson-Mikity syndrome (WMS) had no RDS but had early appearance of bubbly lung on chest x-ray, and infants with chronic pulmonary insufficiency of prematurity (CPIP) had only hazy appearance on chest x-ray. The incidence of CLD in infants who survived beyond 28 days was 50.7% (36/71). Among the 36 infants with CLD, 17 (47%) had BPD, 4 (11%) had WMS and 15 (42%) had CPIP. The median (min, max) days of mechanical ventilation were 45 (9, 112), 45.5 (45, 50) and 7.5 (0, 40) days in BPD, WMS and CPIP groups, respectively. The median (min, max) days of oxygen requirement were 73 (28, 120), 149 (70, 211) and 52.5 (38, 90) days, respectively. The infants still requiring oxygen at post-conceptional age of 36 weeks are significantly more in BPD (14 (82.4%)) and in WMS (4 (100%)) than in CPIP (3 (20%)). Two (1 BPD, 1 WMS) were discharged and received oxygen therapy at home. Four infants with BPD died of respiratory failure. CLD includes a wide range of conditions, from BPD or WMS with severe respiratory morbidity and mortality to no residual problems. Such information is important for design of appropriate strategies to prevent CLD.