Factors affecting the incidence of chronic lung disease of prematurity in 1987, 1992, and 1997
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Published on: November 20, 2015
B N Manktelow1, E S Draper, S Annamalai
1Department of Epidemiology and Public Health, Leicester University Medical School, 22-28 Princess Road West, Leicester LE1 6TP, UK.
Insights
The incidence of chronic lung disease of prematurity increased significantly between 1987 and 1992, but stabilized between 1992 and 1997, despite improved survival rates for premature infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Public Health
Background:
- The incidence of chronic lung disease of prematurity (CLD) has been a significant concern in neonatal intensive care.
- Changes in neonatal care practices may influence CLD rates and survival outcomes for extremely preterm infants.
Purpose of the Study:
- To investigate temporal trends in the incidence of CLD among very preterm infants.
- To assess changes in survival rates for this population over three distinct time periods.
Main Methods:
- An observational study analyzing data from the Trent Health Region, UK, across three periods: 1987, 1992, and 1997.
- Infants born at or before 32 weeks gestation and admitted to neonatal units were included.
- CLD was defined by respiratory support or oxygen dependence at 28 days or 36 weeks corrected age.
Main Results:
- Between 1987 and 1992, there was an increased admission of preterm infants, with a significant rise in CLD incidence despite improved survival after adjusting for gestational age and birth weight.
- From 1992 to 1997, survival rates continued to improve significantly without a corresponding increase in CLD rates.
- Adjusted analysis showed CLD incidence increased (OR 2.20-3.04) from 1987-1992, but stabilized (OR 0.72-0.88) from 1992-1997.
Conclusions:
- Widening access to neonatal intensive care for the most immature infants has contributed to current high CLD rates.
- Recent advancements in neonatal care have enhanced survival for preterm infants without exacerbating CLD risk.
Objective:
To determine changes in the incidence of chronic lung disease of prematurity between 1987, 1992, and 1997.
Methods:
Observational study based on data derived from a geographically defined population: Trent Health Region, United Kingdom. Three time periods were compared: 1 February 1987 to 31 January 1988 (referred to as 1987); 1 April 1992 to 31 March 1993 (referred to as 1992); 1997. All infants of < or = 32 completed weeks gestation born to Trent resident mothers within the study periods and admitted to a neonatal unit were included. Rates of chronic lung disease were determined using two definitions: (a) infants who remained dependent on active respiratory support or increased oxygen at 28 days of age; (b) infants who remained dependent on active respiratory support or increased oxygen at a corrected age of 36 weeks gestation.
Results:
Between 1987 and 1992 there was a fall in the birth rate, but a significant increase was noted in the number of babies of < or = 32 weeks gestation admitted to a neonatal unit. There was no significant change in survival when the two groups of infants were directly compared. However, mean gestation and birth weight fell. Adjusting for this change showed a significant improvement in survival (28 day survival: odds ratio (OR) = 1.69; 95% confidence interval (95% CI) = 1.23 to 2.33. Survival to 36 week corrected gestation: OR = 1.45; 95% CI = 1.06 to 1.98). These changes were accompanied by a large increase in the incidence of chronic lung disease even after allowing for the change in population characteristics (28 day definition: OR = 2.20; 95% CI = 1.47 to 3.30. 36 week definition: OR = 3.04; 95% CI = 1.91 to 4.83). Between 1992 and 1997 a different pattern emerged. There was a further increase in the number of babies admitted for neonatal care at
Conclusions:
Current high rates of chronic lung disease are the result of policies to offer neonatal intensive care more widely to the most immature infants. Recent improvements in survival have been achieved without further increases in the risk of infants developing chronic lung disease.
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