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Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease
M A Rojas1, A Gonzalez, E Bancalari
1Department of Pediatrics, University of Miami School of Medicine, FL 33101, USA.
Insights
Chronic lung disease (CLD) frequently affects very low birth weight infants. Late patent ductus arteriosus (PDA), often with infection, is a primary cause of CLD in these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Perinatal Research
Background:
- Chronic lung disease (CLD) is a significant complication in preterm infants, even those with mild or no initial respiratory distress syndrome (RDS).
- Identifying specific risk factors is crucial for preventing CLD in very low birth weight (VLBW) infants.
Purpose of the Study:
- To investigate risk factors predisposing preterm infants with minimal or no initial respiratory distress syndrome to developing chronic lung disease.
- To elucidate the role of patent ductus arteriosus (PDA) and sepsis in the pathogenesis of CLD in this population.
Main Methods:
- Prospective clinical data collection from 119 ventilator-supported preterm infants (500-1000 gm birth weight) surviving >28 days.
- Multivariate logistic regression analysis to assess risk factors for CLD, including birth weight, PDA, and sepsis.
- Categorization of PDA episodes as early or late, and assessment of symptomatic PDA duration.
Main Results:
- CLD developed in 37% of the studied infants.
- Significant risk factors for CLD included low birth weight, patent ductus arteriosus (PDA), and sepsis.
- Simultaneous PDA and sepsis dramatically increased CLD risk (OR 48.3). Late PDA episodes (OR 21.1) and longer symptomatic PDA duration (OR 3.5/week) were strongly associated with CLD.
Conclusions:
- Chronic lung disease is a common outcome in VLBW infants with mild/no RDS.
- Late-onset PDA, particularly when associated with nosocomial infections, appears to be a primary driver in CLD development.
- Targeting PDA and managing infections are critical for preventing CLD in high-risk preterm infants.
Objective:
To assess the role of specific risk factors that may predispose preterm infants with mild or no initial respiratory distress syndrome to the development of chronic lung disease (CLD).
Study Design:
Clinical data were collected prospectively from 119 ventilator-supported preterm infants with birth weights between 500 and 1000 gm, who survived more than 28 days and required fewer than 3 days of treatment with fraction of inspired oxygen > 25% during the first 5 days of life. Logistic regression analysis was used in a multivariate assessment of risk factors for CLD.
Results:
Chronic lung disease occurred in 44 of the patients (37%). The analysis showed that low birth weight, patent ductus arteriosus (PDA), and sepsis were significant risk factors for CLD. The corresponding odds ratios for CLD and their 95% confidence intervals (CI) were as follows: 2.9 per 100 gm birth weight decrement (CI, 1.7 to 4.8); 6.2 (CI, 2.1 to 18.4) for PDA; and 4.4 (CI, 1.3 to 14.5) for sepsis. When sepsis and PDA occurred simultaneously, the odds ratio for CLD increased to 48.3 (CI, 6.3 to > 100) in comparison with infants without these conditions. Episodes of PDA were categorized as either early (occurring during the first week of life) or late (after the first week), and the respective odds ratios for CLD were 2.8 (CI, 0.8 to 9.4) and 21.1 (CI, 5.6 to 80) in comparison with infants without PDA. For the duration of symptomatic PDA, the odds ratio for CLD was 3.5 per week that the PDA remained open (CI, 1.9 to 6.5).
Conclusion:
CLD is a frequent sequela in very low birth weight infants with mild or no respiratory distress syndrome. In this population, the development of late episodes of PDA, usually in association with a nosocomial infection, seems to play a primary role in the pathogenesis of CLD.