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Published on: October 11, 2011
Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period
A T Shennan1, M S Dunn, A Ohlsson
1Regional Perinatal Unit and Follow-Up Programme, Women's College Hospital, University of Toronto Perinatal Complex, Ontario, Canada.
Insights
Oxygen use at 36 weeks corrected gestational age is a better predictor of abnormal pulmonary outcomes in preterm infants than oxygen use at 28 days. This finding aids in early identification of infants needing further respiratory support.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Perinatal Medicine
Background:
- Premature infants often require respiratory support, including oxygen therapy, due to immature lungs.
- Assessing pulmonary outcomes in very low birth weight infants is crucial for long-term health.
- Early identification of infants at risk for abnormal pulmonary findings is essential for timely intervention.
Purpose of the Study:
- To evaluate the predictive value of neonatal oxygen requirements at different time points for abnormal pulmonary outcomes at 2 years of age in infants with birth weights less than 1,500 grams.
- To compare the efficacy of oxygen use at 28 days versus 36 weeks corrected gestational age in predicting pulmonary status.
Main Methods:
- Retrospective analysis of follow-up data for 605 infants (birth weight < 1,500 g) up to 2 years post-birth.
- Comparison of neonatal oxygen requirements between infants with and without abnormal pulmonary findings.
- Assessment of the positive predictive value of oxygen use at 28 days and 36 weeks corrected gestational age.
Main Results:
- Oxygen requirement at 28 days had a low positive predictive value (38%) for abnormal pulmonary findings.
- Oxygen requirement at 28 days was a less reliable predictor for infants with lower gestational ages.
- Oxygen requirement at 36 weeks corrected gestational age significantly improved prediction of abnormal pulmonary outcomes (63% positive predictive value).
- Infants not requiring oxygen at 36 weeks corrected gestational age had a 90% chance of a normal outcome.
Conclusions:
- Oxygen requirement at 36 weeks corrected gestational age is a more accurate predictor of abnormal pulmonary outcomes in preterm infants than at 28 days.
- Gestational age at birth influences the predictive value of early oxygen use.
- Utilizing corrected gestational age for oxygen assessment enhances the prediction of long-term pulmonary health in high-risk infants.
Abstract:
The follow-up records of 605 infants with birth weights of less than 1,500 g, with data available for 2 years after birth, were examined for evidence of abnormal pulmonary signs or symptoms. A total of 119 infants were identified and the neonatal oxygen requirements of these infants were compared with those of 486 infants who had normal pulmonary function. A requirement for oxygen at 28 days of life had a positive predictive value for abnormal pulmonary findings at the time of follow-up of only 38%, whereas 31% of those with normal pulmonary findings at the time of follow-up were still receiving oxygen at this age. The need for oxygen at 28 days was a good predictor of abnormal findings in infants of greater than or equal to 30 weeks' gestational age at birth but became increasingly less useful as gestational age decreased. It was found that, irrespective of gestational age at birth, the requirement for additional oxygen at 36 weeks' corrected postnatal gestational age was a better predictor of abnormal outcome, increasing the positive predictive value to 63%. The prediction of a normal outcome remained 90% for infants not receiving oxygen at this corrected gestational age.
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