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Frequent wheeze at follow up of very preterm infants: which factors are predictive?
M Thomas1, A Greenough, A Johnson
1Department of Child Health, King's College Hospital, London, UK.
Insights
Chest X-rays at 36 weeks postmenstrual age (PMA) can predict recurrent wheezing in premature infants. This imaging finding is more effective than clinical data for identifying infants at risk of persistent wheeze.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Medical Imaging
Background:
- Premature infants are at high risk for respiratory complications.
- Predicting recurrent wheeze and cough in this population is crucial for timely intervention.
Purpose of the Study:
- To evaluate if chest radiograph (CXR) findings at 28 days and 36 weeks postmenstrual age (PMA) predict recurrent wheeze or cough.
- To compare the predictive efficacy of CXR appearance versus clinical data.
Main Methods:
- Chest radiographs of 185 preterm infants (median gestational age 26 weeks) were analyzed at 28 days and 36 weeks PMA.
- Radiographs were assessed for fibrosis, interstitial shadows, cystic elements, and hyperinflation.
- Wheeze and cough frequency were determined at 6 months corrected age via questionnaire.
Main Results:
- Infants with recurrent wheeze had significantly higher CXR scores at both 28 days and 36 weeks PMA.
- Higher scores for fibrosis at 28 days and fibrosis/cystic elements at 36 weeks PMA were associated with wheezing.
- An abnormal CXR score at 36 weeks PMA showed the highest predictive value for frequent wheeze.
Conclusions:
- Abnormal chest radiograph appearance at 36 weeks PMA is a significant predictor of frequent wheeze in preterm infants.
- CXR findings at 36 weeks PMA appear more effective than clinical data for predicting recurrent wheeze.
Objective:
To determine if chest radiograph appearance at 28 days or 36 weeks postmenstrual age (PMA) can predict recurrent wheeze or cough at follow up in prematurely born infants more effectively than readily available clinical data.
Design:
Chest radiographs of infants entered into the UKOS trial, who had had a chest radiograph at 28 days and 36 weeks PMA and completed six months of follow up, were assessed for the presence of fibrosis, interstitial shadows, cystic elements, and hyperinflation. At 6 months of corrected age, the occurrence and frequency of wheeze and cough since discharge were determined using a symptom questionnaire.
Patients:
A total of 185 infants with a median gestational age of 26 (range 23-28) weeks.
Results:
Thirty seven infants wheezed more than once a week, compared with the rest of the cohort. These infants had significantly higher chest radiograph scores at 28 days (p = 0.020) and 36 weeks PMA (p = 0.005), with significantly higher scores at 28 days for fibrosis (p = 0.017) and at 36 weeks PMA for fibrosis (p = 0.001) and cystic elements (p = 0.0007). They had also been ventilated for longer (p = 0.013). Forty four infants coughed more than once a week; they did not differ significantly from the rest of the cohort. An abnormal chest radiograph score at 36 weeks PMA had the largest area under the receiver operator characteristic curve with regard to prediction of frequent wheeze.
Conclusion:
An abnormal chest radiograph appearance at 36 weeks PMA predicts frequent wheeze at follow up and appears to be a better predictor than readily available clinical data.
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