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Chronic oxygen dependency in infants born at less than 32 weeks' gestation: incidence and risk factors
L Egreteau1, J Y Pauchard, D S Semama
1Collaborative Northern and Eastern France Study Group of Neonatal Intensive Care Units, University of Reims, France. legreteau@chu-reims.fr
Insights
Chronic oxygen dependency (COD) was common in premature infants at 28 days but decreased significantly by 42 weeks postconceptional age. Low gestational age and intrauterine growth restriction were key risk factors for persistent COD.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Perinatal Medicine
Background:
- Premature infants born at or before 31 weeks' gestation are at high risk for respiratory complications.
- Chronic oxygen dependency (COD) is a significant concern in this vulnerable population.
- Identifying risk factors for COD is crucial for improving outcomes in extremely preterm infants.
Purpose of the Study:
- To determine the incidence of chronic oxygen dependency (COD) in survivors born at or before 31 weeks' gestation.
- To identify clinical risk factors associated with the development of COD in this cohort.
Main Methods:
- Prospective, multicenter study of 802 infants born at or before 31 weeks' gestation.
- Oxygenation assessed at 28 days, 36 weeks, and 42 weeks' postconceptional age (PCA).
- Stepwise logistic regression used to identify COD incidence and risk factors.
Main Results:
- Mortality rate was 14%.
- COD incidence was 25% at 28 days, decreasing to 15% at 36 weeks and 6% at 42 weeks' PCA.
- Significant risk factors for COD included lower gestational age, high Clinical Risk Index for Infants score, intrauterine growth restriction, and surfactant treatment.
Conclusions:
- COD incidence is high early in life but significantly declines by 42 weeks' PCA.
- Intrauterine growth restriction and the Clinical Risk Index for Infants are important predictors of COD.
- Findings reinforce the need for close monitoring and targeted interventions for high-risk premature infants.
Objective:
To assess incidence and clinical risk factors of chronic oxygen dependency (COD) among survivors who were born at or before 31 weeks' gestation.
Methods:
This prospective, multicenter study enrolled 802 infants who were born at or before 31 weeks' gestation and admitted to 8 level III neonatal intensive care units in northern and eastern France from January 1 through December 31, 1997. Need for oxygen to maintain oxygen saturation between 92% and 96% was assessed at 28 days of life and at 36 and 42 weeks' postconceptional age (PCA). Stepwise logistic regression analysis was used to identify the incidence of COD and the risk factors related to its occurrence.
Results:
The mortality rate was 14%. Antenatal corticotherapy was administered to 51% of patients, surfactant therapy to 76% of the ventilated patients, and high-frequency oscillatory ventilation at day 1 to 32%. At 28 days and 36 and 42 weeks' PCA, respectively, 25%, 15%, and 6% of survivors had COD. After adjustment for intercenter variations, we identified the significant risk factors for COD at these dates: a low gestational age, a high score on the Clinical Risk Index for Infants, intrauterine growth restriction, and surfactant treatment.
Conclusion:
COD incidence was high at 28 days of life but decreased dramatically by 42 weeks' PCA. This study confirmed previously reported risk factors and underlined the importance of intrauterine growth restriction and the Clinical Risk Index for Infants as significant risk factors.