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Respiratory support and bronchopulmonary dysplasia in infants born at 22-26 weeks gestation in Sweden, 2004-2007 and

Linn Löfberg^1,2, Thomas Abrahamsson^3,2, Lars J Björklund⁴

¹Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden linn.h.lofberg@gmail.com.

The European Respiratory Journal

|November 7, 2024

Insights

Improved survival for extremely preterm infants did not increase overall bronchopulmonary dysplasia (BPD) rates. While severe BPD decreased, moderate BPD rose, indicating a shift in BPD severity despite advanced respiratory support strategies.

Area of Science:

Neonatalogy
Pediatric Pulmonology
Perinatal Epidemiology

Background:

Survival rates for extremely preterm infants (22-26 weeks gestational age) have improved over the past decade.
New ventilation strategies have been implemented to support these vulnerable infants.

Purpose of the Study:

To evaluate the incidence of bronchopulmonary dysplasia (BPD) in extremely preterm infants in Sweden.
To determine if improved survival and new ventilation strategies impacted BPD rates over a ten-year period.

Main Methods:

Comparison of two Swedish population-based cohorts born 2004-2007 and 2014-2016 (GA 22-26 weeks).
Analysis of survival, BPD incidence (any, moderate, severe), and composite outcomes at 36 weeks postmenstrual age (PMA).
Assessment of ventilation strategies including mechanical ventilation, CPAP, and high-flow nasal cannula (HFNC).

Main Results:

Survival to 36 weeks PMA increased from 72% to 81%.
Total days on mechanical ventilation and use of CPAP/HFNC increased.
Incidence of any BPD remained stable (65% vs. 68%), moderate BPD increased (37% vs. 47%), and severe BPD decreased (28% vs. 23%).
Composite outcome of severe BPD or death significantly decreased.

Conclusions:

Increased survival in extremely preterm infants was associated with more respiratory support, but overall BPD rates were unchanged.
A decrease in severe BPD was observed, alongside an increase in moderate BPD, suggesting a shift in disease severity.
These findings highlight the evolving landscape of respiratory morbidity in extremely preterm infants.

Read full analysis

Abstract

Background:

Our aim was to evaluate if increased survival and new ventilation strategies were accompanied by a changed incidence of bronchopulmonary dysplasia (BPD) in Sweden over a decade.

Methods:

Data from two Swedish population-based studies of live-born infants with gestational age (GA) 22-26 weeks, born during 2004-2007 (n=702) and 2014-2016 (n=885), were compared for survival, any BPD, moderate BPD and severe BPD and the composite outcomes of any BPD or death and severe BPD or death at 36 weeks postmenstrual age (PMA). Ventilation strategies and interventions were analysed. Any BPD was defined as the use of supplemental oxygen or any respiratory support at 36 weeks PMA, moderate BPD as nasal cannula with <30% oxygen and severe BPD as ≥30% oxygen, continuous positive airway pressure (CPAP) or mechanical ventilation.

Results:

Survival to 36 weeks PMA increased from 72% to 81% (p<0.001). Total days on mechanical ventilation increased from a median of 9 to 16 days (p<0.001). High-flow nasal cannula (HFNC) was introduced between the cohorts, and days of CPAP and HFNC increased from 44 to 50 days (p<0.001). Any BPD was unchanged at 65% versus 68%. Moderate BPD increased from 37% to 47% (p=0.003), while the incidence of severe BPD decreased from 28% to 23% (p<0.046). Severe BPD or death decreased from 48% to 37% (p<0.001), while any BPD or death remained unchanged at 74% versus 75%.

Conclusion:

Even though an increased survival of infants born at 22-26 weeks GA was accompanied by an increased duration of invasive and non-invasive respiratory support, the incidence of any BPD remained unchanged, while severe BPD decreased in infants alive at 36 weeks PMA.

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