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Prediction of respiratory outcome in extremely low gestational age infants
Richard B Parad1, Jonathan M Davis, Jessica Lo
1Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Mass., USA.
Insights
Respiratory morbidity (RM) at 12 months corrected age better predicts later respiratory issues in extremely preterm infants than bronchopulmonary dysplasia (BPD). This finding aids in assessing long-term respiratory health in high-risk neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Trial Outcomes
Background:
- Bronchopulmonary dysplasia (BPD) is a standard outcome measure in neonatal clinical trials.
- Accurate prediction of long-term respiratory health in extremely preterm infants remains a challenge.
Purpose of the Study:
- To compare the predictive accuracy of BPD diagnosis versus respiratory morbidity (RM) at 12 months corrected age for subsequent respiratory outcomes.
- To evaluate RM definitions (RM1, RM2) and BPD (at 28 days and 36 weeks) in predicting respiratory health at 24 months corrected age.
Main Methods:
- Development and validation cohorts of extremely low gestational age infants (23-28 weeks).
- Pulmonary function tests and parental respiratory diaries at 12 months corrected age.
- Assessment of BPD at 28 days and 36 weeks post-menstrual age.
- Evaluation of RM1 and RM2 based on weekly diary entries for 2 weeks.
- Prediction of respiratory outcomes at 24 months using health questionnaires.
Main Results:
- BPD diagnoses (BPD28d, BPD36w) did not significantly predict any respiratory outcome at 24 months.
- Respiratory morbidity (RM1, RM2) assessed via parental diaries showed significantly better predictive performance than BPD.
- Receiver operating characteristic curve analysis confirmed superior predictive value for RM definitions.
Conclusions:
- Respiratory morbidity, as documented by parental diaries at 12 months corrected age, is a superior predictor of respiratory outcomes at 24 months corrected age compared to BPD.
- These findings suggest refining outcome measures in neonatal trials for extremely preterm infants.
Background:
Bronchopulmonary dysplasia (BPD) is a commonly used outcome for randomized neonatal trials.
Objectives:
The aim of the present study was to determine whether a diagnosis of BPD or respiratory morbidity (RM1 or RM2) at 12 months corrected age better predicted subsequent RM in extremely low gestational age infants (23-28 weeks of gestation).
Methods:
Initial analysis was undertaken in a development cohort of 76 infants who underwent pulmonary function tests (PFTs) at 12 months corrected age. Parents completed infant respiratory diaries 2 weeks before the PFTs. Analysis was then undertaken in a validation cohort of 227 infants whose parents completed a 4-week respiratory diary when their infant was 12 months corrected age. BPD at 28 days (BPD28d) and 36 weeks post-menstrual age (BPD36w), RM1 (≥3 days and/or nights of cough, wheeze, and/or medicine use) and RM2 (≥4 days and/or nights of cough, wheeze, and/or respiratory medicine use) each week for 2 weeks at 12 months corrected age were assessed with regard to prediction of respiratory outcomes at 24 months documented by respiratory health questionnaires.
Results:
BPD28d and BPD36w were not significantly associated with any respiratory outcome. Areas under the receiver operating characteristic curves were significantly better for either definition of RM than BPD28d or BPD36w for all outcomes.
Conclusions:
RM documented by parental completed diaries at 12 months corrected age better predicted respiratory outcome at 24 months corrected age than BPD regardless of diagnostic criteria.
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