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Updated: Nov 10, 2025
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Red cell distribution width as a predictor for bronchopulmonary dysplasia in premature infants
Hayato Go1, Hitoshi Ohto2, Kenneth E Nollet3
1Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan. go-h@fmu.ac.jp.
Insights
Red blood cell distribution width (RDW) measured at 28 days of life can predict bronchopulmonary dysplasia (BPD) in preterm infants. Higher RDW levels at 28 days indicate a greater likelihood and severity of BPD.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Biomarkers
Background:
- Bronchopulmonary dysplasia (BPD) is a common complication in preterm infants, associated with oxidative stress and inflammation.
- Red blood cell distribution width (RDW) reflects red blood cell size variation and is linked to inflammatory processes in various diseases.
Purpose of the Study:
- To investigate perinatal factors influencing RDW in preterm infants.
- To determine if RDW can serve as a predictive biomarker for the development and severity of BPD.
Main Methods:
- A cohort of 176 preterm infants (born <30 weeks gestation) was divided into BPD and non-BPD groups.
- RDW levels were measured at birth, 14 days of life (DOL 14), and 28 days of life (DOL 28).
- Clinical data and perinatal factors were collected and analyzed.
Main Results:
- RDW at DOL 14 and DOL 28 was significantly higher in infants with BPD compared to those without.
- RDW at DOL 28 showed a strong association with BPD, with an odds ratio of 1.63 (P=0.001).
- Receiver operating characteristic analysis indicated RDW at DOL 28 is a reliable predictor of BPD (AUC=0.87).
- RDW levels at DOL 28 correlated with the severity of BPD (mild, moderate, severe).
Conclusions:
- RDW measured at 28 days of life is a potential biomarker for predicting BPD in preterm infants.
- RDW levels at DOL 28 can also indicate the severity of BPD.
- Further research is needed to elucidate the mechanisms linking RDW at DOL 28 to BPD pathogenesis.
Abstract:
Bronchopulmonary dysplasia (BPD) is the most common morbidity complicating preterm birth. Red blood cell distribution width (RDW), a measure of the variation red blood cell size, could reflect oxidative stress and chronic inflammation in many diseases such as cardiovascular, pulmonary, and other diseases. The objectives of the present study were to evaluate perinatal factors affecting RDW and to validate whether RDW could be a potential biomarker for BPD. A total of 176 preterm infants born at < 30 weeks were included in this study. They were categorized into BPD (n = 85) and non-BPD (n = 91) infants. RDW at birth and 14 days and 28 days of life (DOL 14, DOL 28) were measured. Clinical data were obtained from all subjects at Fukushima Medical University (Fukushima, Japan). The mean RDW at birth, DOL 14 and DOL 28 were 16.1%, 18.6%, 20.1%, respectively. Small for gestational age (SGA), chorioamnionitis (CAM), hypertensive disorders of pregnancy (HDP), gestational age and birth weight were significantly associated with RDW at birth. SGA, BPD and red blood cell (RBC) transfusion before DOL 14 were associated with RDW at DOL 14. BPD and RBC transfusion before DOL 14 were associated with RDW at DOL 28. Compared with non-BPD infants, mean RDW at birth DOL 14 (21.1% vs. 17.6%, P < 0.001) and DOL 28 (22.2% vs. 18.2%, P < 0.001) were significantly higher in BPD infants. Multivariate analysis revealed that RDW at DOL 28 was significantly higher in BPD infants (P = 0.001, odds ratio 1.63; 95% CI 1.22-2.19). Receiver operating characteristic analysis for RDW at DOL 28 in infants with and without BPD yielded an area under the curve of 0.87 (95% CI 0.78-0.91, P < 0.001). RDW at DOL 28 with mild BPD (18.3% vs. 21.2%, P < 0.001), moderate BPD (18.3% vs. 21.2%, P < 0.001), and severe BPD (18.3% vs. 23.9%, P < 0.001) were significantly higher than those with non-BPD, respectively. Furthermore, there are significant differences of RDW at DOL 28 between mild, moderate, and severe BPD. In summary, we conclude that RDW at DOL 28 could serve as a biomarker for predicting BPD and its severity. The mechanism by which RDW at DOL 28 is associated with the pathogenesis of BPD needs further elucidation.
