Bronchopulmonary dysplasia and postnatal growth following extremely preterm birth

ObjectivesTo report the current incidence of bronchopulmonary dysplasia (BPD) and to compare changes in weight and head circumference between infants who developed BPD and infants who did not.DesignRetrospective, whole-population study.SettingAll neonatal units in England between 2014 and 2018.PatientsAll liveborn infants born <28 completed weeks of gestation.InterventionsThe change in weight z-score (ΔWz) was calculated by subtracting the birthweight z-score from the weight z-score at 36 weeks postmenstrual age (PMA) and at discharge. The change in head circumference z-score (ΔHz) was calculated by subtracting the birth head circumference z-score from the head circumference z-score at discharge.Main outcome measureBPD was defined as the need for any respiratory support at 36 weeks PMA.Results11 806 infants were included in the analysis. The incidence of BPD was 57.5%, and 18.9% of the infants died before 36 weeks PMA. The median (IQR) ΔWz from birth to 36 weeks PMA was significantly smaller in infants who developed BPD (−0.69 (−1.28 to −0.14), n=6105) than in those who did not develop BPD (−0.89 (−1.40 to −0.33), n=2390; adjusted p<0.001). The median (IQR) ΔHz from birth to discharge was significantly smaller in infants who developed BPD (−0.33 (−1.69 to 0.71)) than in those who did not develop BPD (−0.61 (−1.85 to 0.35); adjusted p<0.001).ConclusionsPostnatal growth was better in infants diagnosed with BPD compared with infants without BPD possibly due to more aggressive nutrition strategies.

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The effect of postnatal corticosteroids on growth parameters in infants with bronchopulmonary dysplasia

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0149 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Emma E. Williams ◽

Theodore Dassios ◽

Mikhaela Mann ◽

Anne Greenough

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Head Circumference ◽

Neonatal Intensive Care ◽

Growth Parameters ◽

Corticosteroid Treatment ◽

Postnatal Growth ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

The Difference

Abstract Objectives Corticosteroids are administered to ventilator dependent infants with bronchopulmonary dysplasia (BPD) to improve respiratory function and facilitating extubation. Acutely, however, growth impairment can occur as a side effect of such therapy. We aimed to determine the effect of corticosteroids on postnatal growth during the entire neonatal intensive care unit (NICU) admission. Methods A whole population study of extremely preterm infants with BPD was undertaken. Corticosteroid therapy was classified as treatment with dexamethasone or hydrocortisone for a least five consecutive days. Growth was calculated as the difference in weight and head circumference z-score from birth to discharge. Results Six thousand, one hundred and four infants with BPD were included of whom 28.3% received postnatal corticosteroids. Infants receiving corticosteroids were less mature (GA 25.0 vs. 26.3 weeks) and of lower birthweight (0.70 vs. 0.84 kg) than those not receiving treatment. There were no significant differences between those who did and did not receive corticosteroids in weight gain (p=0.61) or head circumference growth (p=0.33) from birth to discharge. Single vs. multiple courses of postnatal corticosteroids did not result in significant differences in weight (p=0.62) or head circumference (p=0.13) growth. Conclusions Postnatal corticosteroid treatment did not affect the longer term growth of preterm infants with BPD.

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Fate of pulmonary hypertension associated with bronchopulmonary dysplasia beyond 36 weeks postmenstrual age

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-318531 ◽

2020 ◽

Vol 106 (1) ◽

pp. 45-50 ◽

Cited By ~ 1

Author(s):

Sanne Arjaans ◽

Meindina G Haarman ◽

Marcus T R Roofthooft ◽

Marian W F Fries ◽

Elisabeth M W Kooi ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Bronchopulmonary Dysplasia ◽

Medical Center ◽

Survival Rates ◽

Patient Characteristics ◽

University Hospital ◽

Resolution Rate ◽

Extremely Preterm ◽

Postmenstrual Age ◽

Preterm Born

ObjectiveTo determine the survival and evolution of pulmonary hypertension (PH) associated with bronchopulmonary dysplasia (BPD) in extremely premature born infants beyond 36 weeks postmenstrual age (PMA).DesignA single-centre retrospective cohort study from a university hospital.PatientsExtremely preterm (gestational age <30 weeks and/or birth weight <1000 g) infants, born between 2012 and 2017, in the University Medical Center Groningen with confirmed PH at/beyond 36 weeks PMA.Main outcome measuresSurvival, mortality rate and PH resolution. Patient characteristics, treatment, presence and evolution of PH were collected from patient charts.ResultsTwenty-eight infants were included. All had BPD, while 23 (82%) had severe BPD and 11 infants (39%) died. Survival rates at 1, 3 and 7 months from 36 weeks PMA were 89%, 70% and 58%, respectively. In 16 of the 17 surviving infants, PH resolved over time, with a resolution rate at 1 and 2 years corrected age of 47% and 79%, respectively. At 2.5 years corrected age, the resolution rate was 94%.ConclusionsThese extremely preterm born infants with PH-BPD had a survival rate of 58% at 6 months corrected age. Suprasystemic pulmonary artery pressure was associated with poor outcome. In the current study, infants surviving beyond the corrected age of 6 months showed excellent survival and resolution of PH in almost all cases. Prospective follow-up studies should investigate whether resolution of PH in these infants can be improved by multi-modal therapies, including respiratory, nutritional and cardiovascular treatments.

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Aggressive nutrition in extremely low birth weight infants: impact on parenteral nutrition associated cholestasis and growth

PeerJ ◽

10.7717/peerj.2483 ◽

2016 ◽

Vol 4 ◽

pp. e2483 ◽

Cited By ~ 12

Author(s):

Andreas Repa ◽

Ruth Lochmann ◽

Lukas Unterasinger ◽

Michael Weber ◽

Angelika Berger ◽

...

Keyword(s):

Body Weight ◽

Birth Weight ◽

Low Birth Weight ◽

Parenteral Nutrition ◽

Head Circumference ◽

Postnatal Growth ◽

The Body ◽

Extremely Low Birth Weight ◽

Secondary Outcome ◽

Z Score

BackgroundParenteral nutrition associated cholestasis (PNAC) is a frequently observed pathology in extremely low birth weight (ELBW) infants. Its pathogenesis is determined by the composition and duration of parenteral nutrition (PN) as well as the tolerance of enteral feeds (EF). “Aggressive” nutrition is increasingly used in ELBW infants to improve postnatal growth. Little is known about the effect of “aggressive” nutrition on the incidence of PNAC. We analyzed the influence of implementing an “aggressive” nutritional regimen on the incidence of PNAC and growth in a cohort of ELBW infants.MethodsELBW infants were nourished using a “conservative” (2005–6;n= 77) or “aggressive” (2007–9;n= 85) nutritional regimen that differed in the composition of PN after birth as well as the composition and timing of advancement of EFs. We analyzed the incidence of PNAC (conjugated bilirubin > 1.5 mg/dl (25 µmol/l)) corrected for confounders of cholestasis (i.e., NEC and/or gastrointestinal surgery, sepsis, birth weight, Z-score of birth weight, time on PN and male sex), growth until discharge (as the most important secondary outcome) and neonatal morbidities.ResultsThe incidence of PNAC was significantly lower during the period of “aggressive” vs. “conservative “nutrition (27% vs. 46%,P< 0.05; adjusted OR 0.275 [0.116–0.651],P< 0.01). Body weight (+411g), head circumference (+1 cm) and length (+1 cm) at discharge were significantly higher. Extra-uterine growth failure (defined as a Z-score difference from birth to discharge lower than −1) was significantly reduced for body weight (85% vs. 35%), head circumference (77% vs. 45%) and length (85% vs. 65%) (P< 0.05). The body mass index (BMI) at discharge was significantly higher (11.1 vs. 12.4) using “aggressive” nutrition and growth became more proportionate with significantly less infants being discharged below the 10th BMI percentile (44% vs. 9%), while the percentage of infants discharged over the 90th BMI percentile (3% vs. 5%) did not significantly increase.Discussion“Aggressive” nutrition of ELBW infants was associated with a significant decrease of PNAC and marked improvement of postnatal growth.

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Endothelial progenitor cells, bronchopulmonary dysplasia and other short-term outcomes of extremely preterm birth

Early Human Development ◽

10.1016/j.earlhumdev.2011.03.011 ◽

2011 ◽

Vol 87 (7) ◽

pp. 461-465 ◽

Cited By ~ 17

Author(s):

Giulia Paviotti ◽

Gian Paolo Fadini ◽

Elisa Boscaro ◽

Carlo Agostini ◽

Angelo Avogaro ◽

...

Keyword(s):

Preterm Birth ◽

Progenitor Cells ◽

Endothelial Progenitor Cells ◽

Bronchopulmonary Dysplasia ◽

Short Term ◽

Endothelial Progenitor ◽

Extremely Preterm ◽

Extremely Preterm Birth

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Sex differences in postnatal weight gain trajectories of extremely preterm newborns

Journal of Perinatology ◽

10.1038/s41372-021-01099-2 ◽

2021 ◽

Author(s):

Fu-Sheng Chou ◽

Hung-Wen Yeh

Keyword(s):

Sex Differences ◽

Weight Gain ◽

Fixed Effects ◽

Postnatal Growth ◽

Z Score ◽

Equivalent Age ◽

Extremely Preterm ◽

Postnatal Weight Gain ◽

Weight Trajectories ◽

Preterm Newborns

Abstract Objective Both postnatal growth and sex play a crucial role in long-term outcomes of extremely preterm newborns (EPNs), but the relationship between sex and postnatal growth is not clear. This study aims to assess sex differences in weight trajectories. Study design Weight data in the first 200 days of life from 4327 EPNs were used for generalized additive mixed modeling. We considered gestational age and sex as fixed-effects, and included random intercepts and random slopes for postnatal age. We assessed interactions between fixed-effects and postnatal age. Results Male EPNs had higher predicted weight trajectories than females. Weight z-score trajectories decreased in both sexes before term-equivalent age comparably, but females showed faster increases afterward. Although weight gain velocity was comparable between both sexes, weight gain velocity in male EPNs was lower compared to the corresponding reference values from the 2013 Fenton growth charts, which explained slower z-score rises. Conclusion Sex disparity exists in postnatal weight gain trajectories of EPNs after reaching the term-equivalent age.

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Prolonged ventilation and postnatal growth of preterm infants

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0278 ◽

2019 ◽

Vol 48 (1) ◽

pp. 82-86 ◽

Cited By ~ 2

Author(s):

Emma Williams ◽

Theodore Dassios ◽

Kate Arnold ◽

Ann Hickey ◽

Anne Greenough

Keyword(s):

Mechanical Ventilation ◽

Gestational Age ◽

Head Circumference ◽

Invasive Mechanical Ventilation ◽

Postnatal Growth ◽

Z Score ◽

Prolonged Ventilation ◽

Gestational Age At Birth ◽

Age At Birth ◽

Prematurely Born Infants

AbstractBackgroundExtremely premature infants often need invasive respiratory support from birth, but have low nutritional reserves and high metabolic demands. Our aim was to determine if there was a relationship between prolonged ventilation and reduced postnatal growth in such infants.MethodsA retrospective, observational study was undertaken. Data from infants born at less than 28 weeks of gestational age and ventilated for 7 days or more were collected and analysed including gestational age, gender, birth and discharge weight, birth and discharge head circumference, days of invasive mechanical ventilation and use of postnatal corticosteroids. The duration of invasive mechanical ventilation and the differences in weight (ΔWz) and head circumference (ΔHz) z-score from birth to discharge were calculated.ResultsFifty-five infants were studied with a median [interquartile range (IQR)] gestational age at birth of 25.3 (24.3–26.7) weeks and birth weight of 0.73 (0.65–0.87) kg. The median duration of mechanical ventilation was 45 (33–68) days. Both ΔWz and ΔHz were significantly negatively correlated to the number of invasive mechanical ventilation days (P = 0.01 and P = 0.03, respectively), but not to the use of postnatal corticosteroids.ConclusionPoor postnatal growth is significantly negatively associated with a longer duration of mechanical ventilation in extremely prematurely born infants.

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The Association between early Gram-negative bacteria in tracheal aspirate cultures and severe bronchopulmonary dysplasia among extremely preterm infants requiring prolonged ventilation

American Journal of Perinatology ◽

10.1055/a-1580-3069 ◽

2021 ◽

Author(s):

Yousuke Imanishi ◽

Katsuya Hirata ◽

Masatoshi Nozaki ◽

Narutaka Mochizuki ◽

Shinya Hirano ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Neonatal Intensive Care ◽

Tracheal Aspirate ◽

Multivariable Logistic Regression Analysis ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Postmenstrual Age

Objective: To evaluate the association between bronchopulmonary dysplasia (BPD) development at 36 weeks postmenstrual age (PMA) and Gram-negative bacteria in tracheal aspirate cultures among extremely preterm infants. Study Design: Retrospective cohort study. Patients were 155 infants aged less than or equal to 26 gestational weeks who were admitted to the neonatal intensive care unit of Osaka Women’s and Children’s Hospital from 2009 to 2018. Primary outcome was respiratory outcomes expressed as BPD development. Multivariable logistic regression analysis was used to identify neonatal and bacterial factors associated with BPD. Results: After adjusting for gestational age, birth weight, sex, chorioamnionitis, Gram-positive cocci (GPC) and Gram-negative rods (GNRs) in tracheal aspirate cultures within 28 days after birth, GNRs were significantly associated with BPD development (odds ratio [OR]: 3.88, 95% confidence interval [CI]: 1.68–8.94). In contrast, GPC were not associated with BPD development (OR: 0.47, 95% CI: 0.05–1.61). Conclusion: Gram-negative bacteria in tracheal cultures within 28 days of birth are associated with BPD development in infants aged less than or equal to 26 gestational weeks.

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Pulmonary Gas Exchange Improves over the First Year in Preterm Infants with and without Bronchopulmonary Dysplasia

Neonatology ◽

10.1159/000513357 ◽

2021 ◽

Vol 118 (1) ◽

pp. 98-105

Author(s):

Y. Jane Choi ◽

Benjamin Stoecklin ◽

Naomi R. Hemy ◽

Graham L. Hall ◽

Dorota A. Doherty ◽

...

Keyword(s):

Gas Exchange ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Pulmonary Gas Exchange ◽

First Year ◽

Term Infants ◽

Extremely Preterm ◽

Postmenstrual Age ◽

First Year Of Life ◽

The Impact

Background: Right shift of the peripheral oxyhaemoglobin saturation (SpO2) versus inspired oxygen pressure (PIO2) curve is a sensitive marker of pulmonary gas exchange. Objectives: The aim of this study was to assess the impact of prematurity and bronchopulmonary dysplasia (BPD) on gas exchange and right-to-left shunt in the neonatal period, and its evolution over the first year of life. Method: We assessed shift and shunt in extremely preterm (EP) and very preterm (VP) infants at 36 and 44 weeks’ postmenstrual age (PMA), and at 1-year corrected postnatal age (cPNA). PIO2 was decreased stepwise to achieve SpO2 between 85 and 98%. Shift and shunt were calculated from paired SpO2/PIO2 measurements using customized software. Results were examined cross-sectionally at each time point, and longitudinally using generalized linear regression. Term infants were assessed at 44 wk PMA as a comparative reference. Results: Longitudinal modelling showed continuous decline in shift in EP and VP infants during the first year of life. There was no difference in shift compared to term infants at 44 wk PMA (p = 0.094). EP infants with BPD had higher shift than infants without BPD at 36 wk PMA (p < 0.001) and 44 wk PMA (p = 0.005) but not at 1-year cPNA. Conclusions: In the absence of lung disease, prematurity per se did not result in reduced gas exchange at 1-year cPNA. We report ongoing, significant improvements in pulmonary gas exchange in all preterm infants during the first year of life, despite evidence of early deficits in gas exchange in EP infants with BPD.

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