The Effect of Initial Mode of Respiratory Support on Bronchopulmonary Dysplasia in Extremely Low Birth Weight Preterm Infants

Abstract

Objectives: Despite improvements in neonatal care and survival of preterm infants, the incidence of bronchopulmonary dysplasia (BPD) is not decreasing. The aim of this study was to evaluate the impact of initial mode of respiratory support on BPD in extremely low birth weight (ELBW) infants. Materials and Methods: ELBW infants admitted to neonatal intensive care unit were analyzed retrospectively between 2014 and 2017. The effects of initial respiratory support options and morbidities on BPD were evaluated between infants who developed BPD or not. Results: Total 101 infants were evaluated, and 68 were included. For those whose incidence of BPD was 46%, the mean gestational age and birth weight were 27.8±1.8 weeks and 814±118 g, respectively. Patients with BPD (n=31) had a lower mean gestational age and birth weight, higher rates of necrotizing enterocolitis and retinopathy of prematurity (p<0.001, p=0.012, p=0.024, and p=0.018, respectively). Requirement of surfactant and need for invasive respiratory support initially after birth were found to be major risk factors for BPD. The duration of invasive ventilation after birth was longer in patients with BPD (p=0.034). BPD or death occurred in 66 of 101 infants. Infants received non-invasive respiratory support after birth had a lower risk for BPD, and BPD or death. Conclusion: To prevent the development of BPD in ELBW infants, the respiratory support should be non-invasive after birth, and if the infant is intubated, duration of invasive respiratory support should be shortened for less than 3 days.

Keywords

• Preterm
• Infant
• Bronchopulmonary Dysplasia
• Extremely Low Birth Weight
• Respiratory

Aşırı Düşük Doğum Ağırlıklı Prematüre Bebeklerde Başlangıç Solunum Desteğinin Bronkopulmoner Displazi Üzerine Etkisi

Abstract

Amaç: Yenidoğan bakımındaki gelişmelere ve prematüre bebeklerin sağkalım oranlarında artışa rağmen bronkopulmoner displazi (BPD) sıklığı azalmamaktadır. Bu çalışmanın amacı, aşırı düşük doğum ağırlıklı (ADDA) bebeklerde solunum desteği başlangıç yönteminin BPD üzerine etkisini değerlendirmektir. Gereç ve Yöntem: 2014-2017 yılları arasında yenidoğan yoğun bakım ünitesine yatırılan ADDA bebekler geriye dönük olarak analiz edildi. BPD gelişen veya gelişmeyen bebeklerde başlangıç solunum desteği yöntemleri ve morbiditelerin BPD üzerine etkisi değerlendirildi. Bulgular: Değerlendirilen toplam 101 bebeğin 68’i dahil edildi. BPD sıklığı %46 olarak saptanan bebeklerin ortalama gebelik haftası 27,8±1,8 hafta ve doğum ağırlığı 814±118 g idi. BPD’li hastaların (n=31) gebelik haftası ve doğum ağırlığı daha düşük, nekrotizan enterokolit ve prematüre retinopati sıklığı daha yüksekti (sırasıyla p<0,001, p=0,012, p=0,024 ve p=0,018). Sürfaktan gereksinimi ve doğumdan sonra invaziv solunum desteği gereksiniminin BPD gelişimi için majör risk faktörleri olduğu saptandı. İnvaziv ventilasyon süresi BPD’li hastalarda daha uzundu (p=0,034). BPD veya ölüm, 101 bebeğin 66’sında gelişti. Yaşamın ilk gününde non-invaziv solunum desteği almanın BPD ve BPD veya ölüm riskini azalttığı saptandı. Sonuç: ADDA’lı bebeklerde BPD’yi önlemek için, doğum sonrası başlangıç solunum desteği non-invaziv olmalı ve eğer bebek entübe ise invaziv solunum desteği süresi 3 günden kısa olmalıdır.

Keywords

• Prematüre
• Bebek
• Bronkopulmoner Displazi
• Aşırı Düşük Doğum Ağırlığı
• Solunum

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