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[Bronchopulmonary dysplasia. Course over 3 years in 88 children born between 1984 and 1988]
D Valleur-Masson1, M Vodovar, J Zeller
1Centre d'Action Médico-Sociale Précoce, l'Institut de Puériculture de Paris IPP.
Insights
Bronchopulmonary dysplasia (BD) increases risks for premature infants born after 31 weeks gestation, impacting survival and neurodevelopment. Infants with BD faced higher mortality and more frequent neurodevelopmental impairments by age two.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Developmental Pediatrics
Context:
- Bronchopulmonary dysplasia (BD) significantly affects infant survival and long-term outcomes.
- Infant maturity, BD severity, and nutritional status are key determinants of prognosis.
- Chronic pulmonary failure's role in growth and development post-BD requires further evaluation.
Purpose:
- To assess the impact of chronic pulmonary failure on growth and development in infants recovering from bronchopulmonary dysplasia (BD).
- To compare neurodevelopmental outcomes of infants with BD to those without BD at two years of age.
- To identify risk factors associated with neurodevelopmental impairment in infants with BD.
Summary:
- A cohort of 88 infants with BD (gestational age 25-41 weeks) were studied, with outcomes compared to 272 infants without BD.
- At two years, 16/64 infants with BD were handicapped, 13 doubtful, and 35 normal. Risk factors included brain abnormalities, small head circumference, and prolonged oxygen/hospitalization.
- Infants with BD showed higher mortality (24% vs. 3.7%) and more neurodevelopmental impairment, particularly those born after 31 weeks gestation.
Impact:
- Bronchopulmonary dysplasia (BD) presents an elevated risk for survival and neurodevelopment in infants born after 31 weeks gestation.
- Identifies critical risk factors like brain abnormalities and prolonged respiratory support, guiding early intervention strategies.
- Highlights the need for specialized follow-up care for infants with BD to mitigate long-term developmental challenges.
Background:
The survival and outcome of infants with bronchopulmonary dysplasia (BD) depend on the patient's maturity, the severity of the BD and nutritional problems. This study evaluates the specific role of chronic pulmonary failure in the growth and development of infants recovering from BD.
Population And Methods:
88 infants admitted for BD from January 1984 to December 1988, having gestational age from 25 to 41 weeks 5 days (mean: 29) and birth weight from 680 to 3,400 g (mean: 1,195) were studied. All infants were given respiratory support for 6 to 914 days (mean 84) and oxygen therapy for 28 to 1,232 days (mean: 119). 29 infants were given corticosteroids for more than 1 month. The outcome of the 80 infants with gestational ages of less than 33 weeks was compared to that of 272 infants with the same gestational age but not suffering from BD on their 28th day. The infants in both groups were examined at 2 years of age and classified as: a) handicapped (neurologic deficit, IQ < 80, hearing loss, blindness, convulsions); b) doubtful (transitory neurology dysfunction); c) normal.
Results:
Of the 88 infants still living at the age of 28 days, 19 died before the age of 2 years: 16 of the 64 surviving infants who could be followed until the age of 2 years were classified as handicapped, 13 were considered doubtful and 35 were normal. The more significant risk factors for neurodevelopmental impairment were: a) the presence of porencephaly and/or ventricular dilatation on brain ultrasonography; b) head circumference < -2 SD at the end of hospital stay; c) oxygen therapy and hospitalization > 5-6 months. The group of infants with BD had a higher death rate (24% vs. 3.7 in the group without BD) and more frequent neurodevelopmental impairment at gestational ages of > 31-32 weeks.
Conclusions:
BD is an extra risk for the survival and neurodevelopment of infants with gestational age > 31 weeks.