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Metabolic acidosis as a risk factor for bronchopulmonary dysplasia in preterm infants born between 23 + 0 and 31 + 6

T W Shin1, E J Lee1, H W Choi2

  • 1Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.

Frontiers in Pediatrics
|July 4, 2025
PubMed

Insights

Metabolic acidosis in preterm infants on day 6 of life is linked to increased risk of bronchopulmonary dysplasia (BPD) or death. This finding suggests metabolic acidosis may be a modifiable risk factor for BPD in premature infants.

Area of Science:

  • Neonatology
  • Pediatric Pulmonology
  • Neonatal Intensive Care

Background:

  • Metabolic acidosis is common in preterm infants but its role in bronchopulmonary dysplasia (BPD) is unclear.
  • Preterm infants born between 23 + 0 and 31 + 6 weeks gestation are at risk for BPD.
  • Understanding risk factors for BPD is crucial for improving outcomes in premature infants.

Purpose of the Study:

  • To investigate the association between metabolic acidosis and moderate/severe BPD or mortality in preterm infants.
  • To determine if metabolic acidosis is an independent risk factor for BPD in premature infants.
  • To explore the relationship between fluid balance and metabolic acidosis in the context of BPD.

Main Methods:

  • Retrospective review of 168 preterm infants (<32 weeks gestation) with complete data.
  • Analysis of daily blood gas parameters (pH, base excess, bicarbonate, lactate) during the first 14 days of life.
  • Inverse probability of treatment weighting (IPTW) used to adjust for confounders like gestational age, fluid balance, and respiratory support.

Main Results:

  • Metabolic acidosis on day 6 of life (DOL 6) was significantly associated with moderate/severe BPD or mortality (OR: 1.369).
  • Infants who developed BPD or died had significantly different cumulative fluid intake during the first and second weeks.
  • IPTW adjustment confirmed the association between DOL 6 metabolic acidosis and adverse outcomes.

Conclusions:

  • Metabolic acidosis on DOL 6 is associated with an increased risk of moderate/severe BPD or mortality in preterm infants.
  • Metabolic acidosis may represent a modifiable risk factor for BPD, warranting further investigation.
  • Fluid management in preterm infants is complex, and its interaction with metabolic acidosis requires further study to improve respiratory outcomes.
Abstract

Keywords:
bronchopulmonary dysplasiafluid balancemetabolic acidosispreterm infantsrespiratory support

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