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Estimation of mortality risk in chronically ventilated infants with bronchopulmonary dysplasia
D W Overstreet1, J C Jackson, G van Belle
1University of Washington School of Medicine, Seattle.
Insights
Bronchopulmonary dysplasia mortality in premature infants is predicted by mean airway pressure and bacterial sepsis in the first month. Later, mean airway pressure and fraction of inspired oxygen at 60 days predict mortality.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants.
- BPD often necessitates prolonged mechanical ventilation, posing a significant mortality risk.
- Identifying early prognostic factors for BPD mortality is crucial for timely intervention.
Purpose of the Study:
- To identify predictors of mortality at 1 and 2 months of age in neonates with BPD requiring mechanical ventilation.
- To develop a predictive model for BPD-related mortality.
Main Methods:
- Retrospective review of medical records for 144 neonates requiring mechanical ventilation for at least one month.
- Logistic regression analysis to identify significant prognostic factors.
- Development of predictive models using mean airway pressure (MAP) and bacterial sepsis (Bact), and later MAP and fraction of inspired oxygen (FIO2).
Main Results:
- Mean airway pressure at 30 days (MAP30) and bacterial sepsis diagnosis (Bact 0-30) were significant predictors of mortality within the first month (P < .001 and P = .018).
- A predictive formula was derived: chi = -6.510 + 0.4588 (MAP30) + 1.475 (Bact 0-30).
- At 60 days, mean airway pressure (MAP60) and fraction of inspired oxygen (F60) were the best predictors of mortality, with chi = 7.668 + 0.2940 (MAP60) + 5.935 (F60).
Conclusions:
- Early identification of mechanical ventilation parameters and sepsis is vital for predicting BPD mortality.
- MAP and FIO2 at 60 days provide a strong basis for predicting later mortality in BPD patients.
- These findings can aid in risk stratification and management strategies for premature infants with BPD.
Abstract:
Bronchopulmonary dysplasia is a chronic, sometimes fatal lung disease, which primarily affects premature infants and often leads to a dependence on mechanical ventilation lasting many months. To identify prognostic factors of mortality at 1 and 2 months of age, the authors reviewed the medical records of the 144 neonates admitted to two neonatal intensive care units in Seattle from January 1, 1986, through December 31, 1988, who required mechanical ventilation throughout the first month of life. Likely predictors of mortality were tested by logistic regression analysis. The calculated mean airway pressure at 30 days of age (MAP30) and the diagnosis of bacterial sepsis at any time during the first month of life (Bact 0-30) were statistically significant predictors of mortality (P less than .001 and P = .018, respectively) and had the lowest deviance in the regression model. The probability of mortality was estimated by 1/(1 + e-chi), where chi = -6.510 + 0.4588 (MAP30) + 1.475 (Bact 0-30), and where MAP30 is expressed as centimeters of water pressure (1 cm H2O = 0.0978 kPa) and the presence or absence of bacteremia is 1 and 0, respectively. The records of the 57 infants who still required mechanical ventilation at 60 days of age were reanalyzed with clinical data available during the first 2 months of life. Mean airway pressure (MAP 60) and the fraction of inspired oxygen (F60) at 60 days of age combined to form the best predictors of mortality, where chi = 7.668 + 0.2940 (MAP 60) + 5.935 (F60).(ABSTRACT TRUNCATED AT 250 WORDS)