Year: 2022
Type: dissertation
Study design: Observational Study
Abstract: Objective To investigate recent trends in bronchopulmonary dysplasia (BPD) and its risk factors among extremely preterm infants. Study designDemographic and clinical data were reviewed for 19 370 infants born at 22-27 weeks of gestation registered in the affiliated hospitals of the Neonatal Research Network of Japan between 2003 and 2016.We investigated the overall survival and prevalence of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age and risk factors for developing BPD among the survivors. ResultsAmong 19 370 infants, 2244 (11.6%) died by 36 weeks' postmenstrual age.The mortality rate decreased from 19.0% (99% CI, 15.7%-22.8%) in 2003 to 8.0% (99% CI, 6.2%-10.3%) in 2016.Among 17 126 survivors, BPD developed in 7792 (45.5%) infants, and its proportion significantly increased from 41.4% (99% CI, 36.5%-46.4%) in 2003 to 52.0% (99% CI, 48.2%-55.9%) in 2016.A multivariable analysis of the survivors showed a positive association of BPD with ³4 weeks' supplemental oxygen or invasive ventilation, birth weight <750 g, small for gestational age, ³4 weeks' noninvasive positive pressure ventilation, chorioamnionitis, <26 weeks' gestational age, <20 cases per year of center patient volume, or treated patent ductus arteriosus.Although the median duration of invasive ventilation was shortened, the proportions of factors associated adversely with BPD generally showed increasing trends over time. ConclusionsThe mortality rate of extremely preterm infants has decreased, but the rate of BPD has increased in survivors between 2003 and 2016.Despite the decreasing duration of invasive ventilation over time, increasing rates of BPD suggest that differences in the patient population or other management strategies influence the development of BPD.(J Pediatr 2021;230:119-25). Bronchopulmonary dysplasia (BPD), a chronic lung disease of prematurity, is one of the most common and serious complications affecting extremely preterm infants (born at 22-27 weeks of gestation). 1 Infants with BPD require prolonged stays in neonatal intensive care units (NICUs).After discharge, many patients require home oxygen therapy and often experience rehospitalizations owing to reactive airway disease and an increased susceptibility to viral infections. 2 BPD gives rise to not only long-term respiratory problems, but also life-long morbidity in preterm infants, including neurodevelopmental impairment.3,4 The pathogenesis of BPD is multifactorial, and oxygen toxicity and ventilator-induced lung injury have been recognized as major risk factors for developing BPD.[5][6][7][8] A variety of measures, including antenatal steroids, artificial surfactant administration, less invasive ventilation, and lung protective strategies, have thus been introduced in practice and are used worldwide in the respiratory support of extremely preterm infants.6,9,10 With recent progress in the respiratory management of preterm infants, there have been significant changes in obstetric practice and neonatal demographics over the past decade.However, information concerning the impact of these changes on the development of BPD is scarce.Therefore, we investigated the recent trends over 14 years in the incidence rate of BPD and its association with risk factors among extremely preterm neonates using a nationwide cohort database in Japan. MethodsThe Neonatal Research Network of Japan database prospectively registered all of the clinical information on infants with a birth weight of £1500 g or gestational age <32 weeks' admitted to the 218 participating NICUs (Appendix; available at www.jpeds. com), accounting for 53.8% of 405 secondary-and tertiary-level NICUs in Japan.We retrospectively analyzed infants who were born alive between January 1, 2003, and December 31, 2016.Decisions regarding the pursuit of active treatment or withdrawal of care were made by neonatologists on the basis of
Author: NAKASHIMA, Toshinori
Institution: National Hospital Organization Kokura Medical Center
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7208095254