The association of the room air challenge with long-term outcomes in extremely preterm infants

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Neurodevelopmental Pediatrics

Background:

• Extremely preterm infants (<27 weeks' gestational age) face significant risks for respiratory morbidity and neurodevelopmental impairment (NDI).
• The room air (RA) challenge is used to diagnose bronchopulmonary dysplasia (BPD) at 36 weeks postmenstrual age, but its prognostic value for long-term outcomes is unclear.

Purpose of the Study:

• To evaluate the association between the results of the RA challenge and outcomes at 2 years' corrected age.
• To determine if the RA challenge predicts death, respiratory morbidity, or neurodevelopmental impairment in extremely preterm infants.

Main Methods:

• A cohort study included infants born before 27 weeks' gestational age.
• Infants underwent an RA challenge to diagnose BPD at 36 weeks postmenstrual age.
• Outcomes including death, respiratory morbidity, and NDI were assessed at 2 years' corrected age.

Main Results:

• Of 1022 eligible infants, 554 underwent the RA challenge, with 223 passing.
• RA challenge results were not associated with death or serious respiratory morbidities (aRR 1.01, 95% CI 0.65-1.56).
• RA challenge results were not associated with death or moderate/severe NDI (aRR 1.06, 95% CI 0.81-1.39).

Conclusions:

• The RA challenge results did not correlate with differences in respiratory or neurodevelopmental outcomes at 2 years.
• The findings suggest the RA challenge lacks prognostic value in contemporary extremely preterm infants.
• Further research may be needed to identify more reliable predictors of long-term outcomes in this population.