Antenatal and Postnatal Risk Factors for Bronchopulmonary dysplasia: Single-center Experience

Öz

Objective: Bronchopulmonary dysplasia (BPD) is the chronic lung disease of prematurity that affects a substantial proportion of extremely preterm infants. We aimed to find out the antenatal and postnatal risk factors for BPD in a large-scale cohort of preterm infants.

Material and Methods: Records of preterm infants born <32 gestational weeks and <1500 g were included in this single-center retrospective study that was performed between January 2014 and December 2018. While babies with moderate and severe BPD constituted the study group, the control group included those with mild BPD and without BPD. Groups were compared in terms of antenatal and postnatal risk factors.

Results: In the final analysis, data of 626 infants were recorded. The mean gestational age and birth weight of the whole cohort were 28±1.4 weeks and 1084±225 g, respectively. Ninety-seven (15.4%) infants in the study group had significantly lower gestational age and birth weight compared to those in the control group (27±1.5 vs 28.3±1.7 weeks, and 933±201 vs 1108±256 g respectively, p<0.05). Extensive resuscitation in the delivery room (OR 2.64, Cl [1.57-4.4]), low gestational age (OR 0.80 Cl [0.67-0.95]), hemodynamically significant patent ductus arteriosus (hsPDA) (OR 1.78 Cl [1.05-3.03]) and delayed full enteral feeding (OR 1.05 Cl [1.02-1.08]) were associated with a higher rate of moderate-to-severe BPD.

Conclusion: Large-scale randomized controlled trials are warranted to elucidate whether the association of hsPDA and delayed full enteral feeding with BPD is a real cause and effect relationship or a component of illness state during the process of evolving BPD. 

Anahtar Kelimeler

• Bronchopulmonary dysplasia
• Enteral nutrition
• Prematurity

Orta-Ağır Bronkopulmoner Displazide Tek Merkez Deneyimi: Antenatal ve Postnatal Risk Faktörleri

Öz

Amaç: Bronkopulmoner displazi (BPD), çok düşük doğum ağırlıklı her üç bebekten birini etkileyen uzun dönem ciddi olumsuz sonuçları olan bir prematüre morbiditesidir. Bu çalışmada orta-ağır BPD için antenatal ve postnatal risk faktörlerini araştırmayı amaçladık.

Gereç ve Yöntemler: Tek merkezli retrospektif kohort çalışmada Ocak 2014-Aralık 2018 tarihleri arasında doğan <32 hafta ve <1500 g bebekler dahil edildi. Orta-ağır BPD tanılı hastalar çalışma grubunu, hafif BPD ve BPD tanısı olmayan hastalar kontrol grubunu oluşturdu. Her iki grup antenatal ve postnatal özellikleri açısından karşılaştırıldı.

Bulgular: 626 bebekten oluşan kohortun ortalama gestasyonel yaş ve doğum ağırlığı sırasıyla 28±1.4 hafta ve 1084±225 g’dı. Orta-ağır BPD tanılı 97 bebeğin (%15.4) ortalama gestasyonel yaş ve doğum ağırlıkları, kontrol grubuna göre anlamlı olarak düşük saptandı (27±1.5 ve 28.3±1.7 hafta; 933±201 ve 1108±256 g sırasıyla; p<0.001). Doğum salonunda ileri canlandırma (OR 2.64, Cl [1.57-4.4]), gestasyonel yaş (OR 0.80 Cl [0.67-0.95]), hemodinamik anlamlı patent duktus arteriozus (haPDA) (OR 1.78 Cl [1.05-3.03]) ve geç tam enteral beslenme (OR 1.05 Cl [1.02-1.08]) orta/ağır BPD ile ilişkili bulundu.

Sonuç: Doğum salonunda ileri canlandırma, düşük gestasyon haftası, haPDA ve geç tam enteral beslenme BPD ile ilişkili bulunmuştur. Ancak tam enteral beslenmeye geçiş süresi ve haPDA ile BPD ilişkisinin neden sonuç mu, yoksa BPD’ye gidiş sürecindeki hastalık durumunun bir parçası olup olmadığının ortaya çıkarılması için geniş çaplı prospektif çalışmalara ihtiyaç olduğu düşünülmüştür.

Anahtar Kelimeler

• bronkopulmoner displazi
• prematürite
• enteral beslenme

Kaynakça

1. Northway Jr WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Eng J Med 1967;276:357-68.
2. Bancalari E, Jain D. Bronchopulmonary dysplasia: 50 years after the original description. Neonatology 2019;115:384-91.
3. Hwang JS, Rehan VK. Recent advances in bronchopulmonary dysplasia: pathophysiology, prevention, and treatment. Lung 2018;196:129-38.
4. Higgins RD, Jobe AH, Koso-Thomas M, Bancalari E, Viscardi RM, Hartert TV, et al. Bronchopulmonary dysplasia: executive summary of a workshop. J Pediatr 2018;197:300-8.
5. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Care Med 2001;163:1723-9.
6. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage a study of infants with birth weights less than 1500 gm. J Pediatr 1978;92:529-34.
7. Neu J. Necrotizing enterocolitis: the search for a unifying pathogenic theory leading to prevention. Pediatr Clin North Am 1996;43:409-32.
8. Bozkurt O, Alyamac Dizdar E, Bidev D, Sari FN, Uras N, Oguz SS. Prolonged minimal enteral nutrition versus early feeding advancements in preterm infants with birth weight g: a prospective randomized trial. J Matern Fetal Neonatal Med 2020;1-7.

9. Malikiwi AI, Lee YM, Davies-Tuck M, Wong FY. Postnatal nutritional deficit is an independent predictor of bronchopulmonary dysplasia among extremely premature infants born at or less than 28 weeks gestation. Early Hum Dev 2019;131:29-35.
10. Wemhöner A, Ortner D, Tschirch E, Strasak A, Rüdiger M. Nutrition of preterm infants in relation to bronchopulmonary dysplasia. BMC Pul Med 2011;11:7.
11. Miller M, Vaidya R, Rastogi D, Bhutada A, Rastogi S. From parenteral to enteral nutrition: A nutrition-based approach for evaluating postnatal growth failure in preterm infants. J Parenter Enteral Nutr 2014;38:489-97.
12. Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006;117:1253–61.
13. Hwang JS, Rehan VK. Recent advances in bronchopulmonary dysplasia: Pathophysiology, prevention and treatment. Lung. 2018;196:129-38.
14. Foglia EE, Jensen EA, Kirpalani H. Delivery room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants. J Perinatol 2017;37:1171-9.
15. Shah PS. Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses. J Perinatol 2009;29:655-61.
16. Klinger G, Sokolover N, Boyko V, Sirota L, Lerner-Geva L, Reichman B, Israel Neonatal Network. Perinatal risk factors for bronchopulmonary dysplasia in a national cohort of very-low-birthweight infants. Am J Obstet Gynecol 2013;208:115.e1-9.
17. Willis KA, Weems MF. Hemodynamically significant patent ductus arteriosus and the development of bronchopulmonary dysplasia. Congenital Heart Dis 2019;14:27-32.
18. Clyman RI. Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity. Semin Perinatol 2018;42:235-42.
19. Clyman RI, Liebowitz M, Kaempf J, Erdeve O, Bulbul A, Hakansson S, PDA TOLERATE Trial Investigators. PDA-TOLERATE Trial: An exploratory randomized controlled trial of treatment of moderate-to-large patent ductus arteriosus at 1 week of age. J Pediatr 2019;205:41-8.