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Published on: August 7, 2017
Differences in clinical and laboratory biomarkers for short and long-term respiratory outcomes in preterm neonates
Richard B Parad1, Janis L Breeze2, Norma Terrin2
1Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Bronchopulmonary dysplasia (BPD) and chronic respiratory morbidity (CRM) in premature infants have different risk factors and biomarkers. Early identification of risk factors is key for future strategies to reduce long-term respiratory issues.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Pulmonary outcomes in premature neonates often focus on short-term morbidities.
- Long-term respiratory outcomes require further investigation.
Purpose of the Study:
- To describe risk factors and biomarkers for short-term (bronchopulmonary dysplasia) and longer-term (chronic respiratory morbidity) respiratory outcomes.
- To explore associations between clinical and laboratory factors and these outcomes in a longitudinal cohort.
Main Methods:
- Prospective follow-up of neonates born at 24-29 weeks gestation to 6-12 months corrected gestational age.
- Exploration of associations between clinical and laboratory risk factors/biomarkers and BPD/CRM.
Main Results:
- Bronchopulmonary dysplasia (BPD) occurred in 42% and chronic respiratory morbidity (CRM) in 47% of infants.
- BPD and CRM showed discordant diagnoses in 41% of cases and were associated with different risk factors and biomarker patterns.
- BPD was linked to factors like lower birthweight and higher oxygen use, while CRM was associated with lower Apgar scores and higher urine vascular endothelial growth factor.
Conclusions:
- Bronchopulmonary dysplasia and chronic respiratory morbidity in premature infants are associated with distinct risk factors and biomarker patterns.
- The concordance between BPD and CRM is weak, suggesting different underlying mechanisms.
- Future strategies to reduce chronic respiratory morbidity should target infants identified by specific early risk factors and biomarkers.
Background:
Pulmonary outcome of premature neonates has focused more on short-term than long-term respiratory morbidities.
Objective:
Describe risk factors/biomarkers associated with short-term (bronchopulmonary dysplasia [BPD]) (supplemental oxygen use at 36 weeks postmenstrual age [PMA]) and longer-term (chronic respiratory morbidity [CRM]) (respiratory related symptoms, medications, medical/emergency visits, hospitalizations at 6-12 months corrected gestational age [CGA]) respiratory outcomes in a longitudinal cohort.
Design/Methods:
Neonates born at 24-29-week gestation were prospectively followed to 6-12-month CGA. Associations between clinical and laboratory risk factors/biomarkers of BPD and CRM were explored.
Results:
Of 86 subjects, 94% survived. Outcomes were available for 89% at 36-week PMA (BPD present in 42% of infants) and 72% at 6-12-month CGA (CRM present in 47% of infants). For the 54 infants with known outcomes for both BPD and CRM, diagnoses were discordant in 41%. BPD was associated with lower birthweight and birthweight Z-score for GA, lower Apgar scores, more surfactant doses, higher SNAPPE-II scores, highest Day 1 inspired oxygen concentration, Day 7 oxygen use, prolonged ventilatory support, bacteremia, necrotizing enterocolitis, and treated patent ductus arteriosus. CRM was associated with lower Apgar scores, Day 7 oxygen use and higher urine vascular endothelial growth factor. Patterns of plasma and urine lipid oxidation products differed in the two outcomes.
Conclusion:
In this hypothesis generating and exploratory study, BPD and CRM were associated with different risk factors/biomarker patterns. Concordance between these two outcomes was weak. Strategies for reducing CRM should be studied in cohorts identified by appropriate early risk factors/biomarkers.
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