Cardiorespiratory Monitoring Data to Predict Respiratory Outcomes in Extremely Preterm Infants
Year: 2023
Type: conference-abstract
Abstract: Rationale: Immature control of breathing is associated with apnea, periodic breathing, intermittent hypoxemia, and bradycardia in extremely preterm infants. However, it is not clear if such events independently predict worse respiratory outcome. Objectives: To determine if analysis of cardiorespiratory monitoring data can predict unfavorable respiratory outcomes at 40 weeks postmenstrual age (PMA) and other outcomes, such as bronchopulmonary dysplasia at 36 weeks PMA. Methods: The Prematurity-related Ventilatory Control (PreVent) study was an observational multicenter prospective cohort study including infants born at 29 weeks of gestation with continuous cardiorespiratory monitoring. The primary outcome was either "favorable" (alive and previously discharged or inpatient and off respiratory medications/O2/support at 40 wk PMA) or "unfavorable" (either deceased or inpatient/previously discharged on respiratory medications/O2/support at 40 wk PMA). Measurements and Main Results: A total of 717 infants were evaluated (median birth weight, 850 g; gestation, 26.4 wk), 53.7% of whom had a favorable outcome and 46.3% of whom had an unfavorable outcome. Physiologic data predicted unfavorable outcome, with accuracy improving with advancing age (area under the curve, 0.79 at Day 7, 0.85 at Day 28 and 32 wk PMA). The physiologic variable that contributed most to prediction was intermittent hypoxemia with oxygen saturation as measured by pulse oximetry, 90%. Models with clinical data alone or combining physiologic and clinical data also had good accuracy, with areas under the curve of 0.84–0.85 at Days 7 and 14 and 0.86–0.88 at Day 28 and 32 weeks PMA. Intermittent hypoxemia with oxygen saturation as measured by pulse oximetry, 80% was the major physiologic predictor of severe bronchopulmonary dysplasia and death or mechanical ventilation at 40 weeks PMA. Conclusions: Physiologic data are independently associated with unfavorable respiratory outcome in extremely preterm infants.
Authors: N. Ambalavanan, D.E. Weese-Mayer, A.M. Hibbs, N. Claure, J.L. Carroll, J.R. Moorman, E. Bancalari, A. Hamvas, R.J. Martin, J.M. Di Fiore, P. Indic, J.S. Kemp, A. Dormishian, K. Krahn, J. Qiu, P.A. Dennery, S.J. Ratcliffe, J. Troendle, D.E. Lake, the Prematurity- Related Ventilatory Control (Pre-Vent) Inve
Institutions: University of Alabama at Birmingham, Lurie Children's Hospital, University of Miami, Arkansas Children's Hospital, University of Virginia, Rainbow Babies & Children's Hospital, Case Western Reserve University, The University of Texas at Tyler, Washington University in St. Louis, Hasbro Children's Hospital, National Institutes of Health, National Heart, Lung, and Blood Institute
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4367607128