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A 15-year survey of chronic lung disease of prematurity
E D Burnard1, E John, D A Todd
1Foundation 41, Westmead, Sydney, Australia.
Insights
Survival rates for low birthweight infants improved, but chronic lung disease (CLD) incidence remained stable. Severity of CLD decreased, though supplemental oxygen use beyond 28 days proved an unreliable indicator for diagnosis.
Area of Science:
- Neonatal intensive care
- Pediatric pulmonology
- Perinatal medicine
Background:
- Infants weighing 500-1,500g require intensive care.
- Chronic lung disease (CLD) is a significant concern in premature infants.
- Long-term outcomes for this vulnerable population require ongoing evaluation.
Purpose of the Study:
- To analyze trends in survival and chronic lung disease (CLD) among very low birthweight infants over time.
- To assess changes in the severity and indicators of CLD.
- To evaluate the relationship between supplemental oxygen use and CLD diagnosis.
Main Methods:
- Retrospective review of in-hospital findings for infants (500-1,500g birthweight) admitted to intensive care.
- Data analyzed at four intervals between 1971 and 1987.
- Comparison of survival rates, CLD incidence, severity (mortality, radiographic changes), and supplemental oxygen use.
Main Results:
- Substantial improvement in survival rates observed over the study period.
- Incidence of CLD in 28-day survivors remained unchanged.
- Severity of CLD diminished, with reduced mortality and radiographic changes.
- Mean conceptual age for discontinuing oxygen was 32 weeks (normal X-ray) vs. 37 weeks (abnormal X-ray).
- CLD diagnosed twice as often using supplemental oxygen beyond 28 days compared to abnormal X-ray, indicating unreliability.
Conclusions:
- While survival has improved, CLD remains a challenge in very low birthweight infants.
- Supplemental oxygen use beyond 28 days is an unreliable sole indicator for CLD diagnosis.
- The heterogeneity of CLD patient groups necessitates careful analysis and material selection for etiological and management studies.
Abstract:
The in-hospital findings for infants of 500-1,500 g birthweight admitted for intensive care over the years 1971-87 were reviewed at four intervals. Survival rate improved substantially. The incidence of chronic lung disease (CLD) in survivors at 28 days of age was unchanged though severity diminished in terms of both mortality and degree of radiographic change. Mean conceptual age for ceasing supplemental oxygen was 32 weeks for those with normal X-rays and 37 weeks for abnormal X-rays regardless of initial degree of immaturity. CLD was diagnosed twice as often when supplemental oxygen beyond 28 days was used as an indicator as against an abnormal X-ray and was hence unreliable for this purpose. Since candidates for CLD are a heterogeneous group care is needed in analysis or selection of material in forming conclusions which concern etiology or management.