Chronic lung disease in very low birthweight infants: a 5-year review

To determine the incidence, clinical spectrum and outcome of very low birthweight (VLBW) infants with chronic lung disease (CLD), and evaluate associated factors.

Retrospective review of 265 VLBW infants managed in the NICU from January 1988 to December 1992.

The overall neonatal survival rate for VLBW infants was 83%. Sixty-five (25%) infants had CLD, of whom 42% had severe CLD. Mortality in infants with CLD was 11%. In contrast with infants without CLD, CLD infants had significantly higher risk of adverse neurodevelopment with cerebral palsy documented in 13.5% and functional disability recorded in 34.6% at 2 years corrected age. Factors associated with the development of CLD included; decreasing birthweight (OR 0.98, CI 0.97-0.99), septicaemia (OR 4.96, CI 1.57-15.65), necrotizing enterocolitis (OR 119.07, CI 4.98-2845.04), hyaline membrane disease (OR 5.34, CI 1.83-15.55), patent ductus arteriosus (OR 4.46, CI 1.75-11.36) and increasing fraction of inspired oxygen concentration in the first week of life (OR 1.09, CI 1.04-1.14).

Chronic lung disease occurs frequently in VLBW infants and is associated with a high incidence of adverse neurodevelopment. Further studies to clarify the role of non-respiratory factors such as patent ductus arteriosus (PDA) and sepsis in the pathogenesis of CLD may reduce the incidence or prevent the development of CLD in these preterm infants.