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Early Neonatal Oxygen Exposure Predicts Pulmonary Morbidity and Functional Deficits at 1 Year
Andrew M Dylag1, Hannah G Kopin2, Michael A O'Reilly1
1Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY.
Insights
Cumulative oxygen exposure in the first two weeks predicts bronchopulmonary dysplasia and 1-year respiratory issues in extremely premature infants. Higher exposure is linked to worse outcomes and altered lung function.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Bronchopulmonary dysplasia (BPD) and long-term respiratory morbidity are significant concerns for extremely low gestational age newborns.
- Early identification of infants at risk for respiratory complications is crucial for timely intervention.
Purpose of the Study:
- To assess the predictive capability of cumulative oxygen exposure thresholds within the first two postnatal weeks for BPD and 1-year pulmonary outcomes.
- To link cumulative oxygen exposure to post-prematurity respiratory disease (PRD), respiratory morbidity score (RMS), and lung function in extremely low gestational age newborns.
Main Methods:
- A prospective cohort study of 704 infants who survived to discharge.
- Cumulative oxygen exposure (OxygenAUC14) thresholds were established to categorize infants into high, intermediate, and low exposure groups.
- Multivariate logistic regression was used to predict PRD, RMS, and pulmonary function z scores at 1-year corrected age.
Main Results:
- High oxygen exposure (≥33.1%) was associated with increased PRD and RMS.
- Intermediate oxygen exposure (29.1%-33.1%) was linked to increased moderate/severe RMS.
- Infants in high/intermediate oxygen groups exhibited decreased forced expiratory volume at 0.5 seconds/forced vital capacity ratio, indicating altered lung function.
Conclusions:
- OxygenAUC14 provides early risk stratification for respiratory morbidity in extremely low gestational age newborns.
- Greater cumulative oxygen exposure is associated with impaired pulmonary function at 1 year, suggesting a predisposition to long-term respiratory issues.
Objective:
To evaluate the predictive value of cumulative oxygen exposure thresholds over the first 2 postnatal weeks, linking them to bronchopulmonary dysplasia (BPD) and 1-year pulmonary morbidity and lung function in extremely low gestational age newborns.
Study Design:
Infants (N = 704) enrolled in the Prematurity and Respiratory Outcomes Program, a multicenter prospective cohort study, that survived to discharge were followed through their neonatal intensive care unit hospitalization to 1-year corrected age. Cumulative oxygen exposure (OxygenAUC14) thresholds were derived from univariate models of BPD, stratifying infants into high-, intermediate-, and low-oxygen exposure groups. These groups were then used in multivariate logistic regressions to prospectively predict post-prematurity respiratory disease (PRD), respiratory morbidity score (RMS) in the entire cohort, and pulmonary function z scores (N = 108 subset of infants) at 1-year corrected age.
Results:
Over the first 14 postnatal days, infants exposed to high oxygen averaged ≥33.1% oxygen, infants exposed to intermediate oxygen averaged 29.1%-33.1%, and infants exposed to low oxygen were below both cutoffs. In multivariate models, infants exposed to high oxygen showed increased PRD and RMS, whereas infants exposed to intermediate oxygen demonstrated increased moderate/severe RMS. Infants in the high/intermediate groups had decreased forced expiratory volume at 0.5 seconds/forced vital capacity ratio.
Conclusions:
OxygenAUC14 establishes 3 thresholds of oxygen exposure that risk stratify infants early in their neonatal course, thereby predicting short-term (BPD) and 1-year (PRD, RMS) respiratory morbidity. Infants with greater OxygenAUC14 have altered pulmonary function tests at 1 year of age, indicating early evidence of obstructive lung disease and flow limitation, which may predispose extremely low gestational age newborns to increased long-term pulmonary morbidity.
Trial Registration:
ClinicalTrials.gov: NCT01435187.
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