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Predictors of chronic lung disease in the 'CPAP era'
A M Groves1, K A Briggs, C A Kuschel
1Newborn Services, National Women's Hospital, Auckland, New Zealand.
Insights
Oxygen requirement at 14 days is a strong predictor of chronic lung disease (CLD) in infants on nasal continuous positive airway pressure (CPAP). Infants needing 30% oxygen or more face a 60% risk of CLD or death.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Chronic lung disease (CLD) is a significant concern in very low birthweight infants.
- Nasal continuous positive airway pressure (CPAP) is a common respiratory support method for these infants.
- Predicting CLD risk is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To identify predictors of CLD in infants requiring nasal CPAP within the first four weeks of life.
- To establish reliable indicators for assessing CLD risk in this vulnerable population.
Main Methods:
- Retrospective case note audit of infants with birthweight ≤ 1250 g.
- Analysis of respiratory support methods, including ventilation and CPAP.
- Evaluation of oxygen requirements at specific time points (10-21 days, 14 days).
Main Results:
- Overall mortality was 19%, with 21% of infants developing CLD.
- For infants on CPAP, the need for supplementary oxygen between 10 and 21 days predicted increased CLD risk.
- Oxygen requirement at 14 days (specifically FiO2 ≥ 0.30) was the most reliable predictor, with a 60% risk of CLD or death.
Conclusions:
- CLD remains prevalent in very low birthweight infants despite the use of CPAP.
- Oxygen requirement at 14 days is the strongest predictor of CLD in infants on CPAP.
- Early identification of high-risk infants (requiring ≥ 30% oxygen at 14 days) can guide management and potentially improve prognosis.
Objective:
To assess predictors of chronic lung disease (CLD), in infants requiring nasal continuous positive airway pressure (CPAP) support in the first 4 weeks of life.
Methods:
A retrospective case note audit of infants of birthweight 1250 g or less was undertaken.
Results:
Of 290 infants identified, 50% were initially treated with ventilation, 41% with CPAP, 4% required no support, and 5% had care withdrawn. Of infants initially treated with CPAP, 23% subsequently required ventilation. Overall mortality was 19%, with a further 21% of infants developing CLD. For infants requiring CPAP support, requirement for supplementary oxygen at between 10 and 21 days predicted increased risk of CLD, and receiver operating characteristic curves suggest requirement for supplementary oxygen at 14 days to be the most reliable cut-off (area under curve = 0.72). Positive predictive values for future CLD or death for FiO2 .25, .30 and .40 while on CPAP at 14 days were 0.56, 0.61 and 0.76, respectively.
Conclusions:
CLD remains prevalent in very low birthweight infants in the CPAP era. Oxygen requirement at 14 days is the strongest predictor of CLD. Infants requiring 30% oxygen or more while on CPAP at 14 days have a 60% risk of subsequent CLD or death.
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