Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study

for the

doi:10.1016/j.jpeds.2017.04.026

Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study

for the

Pediatrics

Research output: Contribution to journal › Article › peer-review

163 Scopus citations

Abstract

Objective To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs). Study design We enrolled ELGANs (<29 weeks’ gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks’ postmenstrual age. We surveyed caregivers at 3, 6, 9, and 12 months’ corrected age to identify postdischarge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheostomy, ventilation), medications, or symptoms (cough/wheeze). Infants were classified as having postprematurity respiratory disease (PRD, the primary study outcome) if respiratory morbidity persisted over ≥2 questionnaires. Infants were classified with severe respiratory morbidity if there were multiple hospitalizations, exposure to systemic steroids or pulmonary vasodilators, home oxygen after 3 months or mechanical ventilation, or symptoms despite inhaled corticosteroids. Mixed-effects models generated with data available at 1 day (perinatal) and 36 weeks’ postmenstrual age were assessed for predictive accuracy. Results Of 724 infants (918 ± 234 g, 26.7 ± 1.4 weeks’ gestational age) classified for the primary outcome, 68.6% had PRD; 245 of 704 (34.8%) were classified as severe. Male sex, intrauterine growth restriction, maternal smoking, race/ethnicity, intubation at birth, and public insurance were retained in perinatal and 36-week models for both PRD and respiratory morbidity severity. The perinatal model accurately predicted PRD (c-statistic 0.858). Neither the 36-week model nor the addition of bronchopulmonary dysplasia to the perinatal model improved accuracy (0.856, 0.860); c-statistic for BPD alone was 0.907. Conclusion Both bronchopulmonary dysplasia and perinatal clinical data accurately identify ELGANs at risk for persistent and severe respiratory morbidity at 1 year. Trial registration ClinicalTrials.gov: NCT01435187.

Original language	English (US)
Pages (from-to)	89-97.e3
Journal	journal of pediatrics
Volume	187
DOIs	https://doi.org/10.1016/j.jpeds.2017.04.026
State	Published - Aug 2017

Funding

Supported by National Heart, Lung, and Blood Institute (U01 HL101456) (PI: Aschner, Vanderbilt), (U01 HL101798) (PI: Keller, University of California, San Francisco), (U01 HL101813) (PI: Pryhuber, University of Rochester), (U01 HL101465) (PI: Hamvas, University of Washington), (U01 HL 101800) (PI: Jobe, Cincinnati Children's Hospital Medical Center), (R01 HL105702) (PI: Voynow, Duke), and (U01 HL101794) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Best Pharmaceuticals for Children Act (PI: B Schmidt). The authors declare no conflicts of interest.

Keywords

prematurity
pulmonary morbidity
wheeze

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jpeds.2017.04.026

Cite this

@article{28fc18d3958a45c797485176685f66e8,

title = "Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study",

abstract = "Objective To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs). Study design We enrolled ELGANs (<29 weeks{\textquoteright} gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks{\textquoteright} postmenstrual age. We surveyed caregivers at 3, 6, 9, and 12 months{\textquoteright} corrected age to identify postdischarge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheostomy, ventilation), medications, or symptoms (cough/wheeze). Infants were classified as having postprematurity respiratory disease (PRD, the primary study outcome) if respiratory morbidity persisted over ≥2 questionnaires. Infants were classified with severe respiratory morbidity if there were multiple hospitalizations, exposure to systemic steroids or pulmonary vasodilators, home oxygen after 3 months or mechanical ventilation, or symptoms despite inhaled corticosteroids. Mixed-effects models generated with data available at 1 day (perinatal) and 36 weeks{\textquoteright} postmenstrual age were assessed for predictive accuracy. Results Of 724 infants (918 ± 234 g, 26.7 ± 1.4 weeks{\textquoteright} gestational age) classified for the primary outcome, 68.6% had PRD; 245 of 704 (34.8%) were classified as severe. Male sex, intrauterine growth restriction, maternal smoking, race/ethnicity, intubation at birth, and public insurance were retained in perinatal and 36-week models for both PRD and respiratory morbidity severity. The perinatal model accurately predicted PRD (c-statistic 0.858). Neither the 36-week model nor the addition of bronchopulmonary dysplasia to the perinatal model improved accuracy (0.856, 0.860); c-statistic for BPD alone was 0.907. Conclusion Both bronchopulmonary dysplasia and perinatal clinical data accurately identify ELGANs at risk for persistent and severe respiratory morbidity at 1 year. Trial registration ClinicalTrials.gov: NCT01435187.",

keywords = "prematurity, pulmonary morbidity, wheeze",

author = "{for the} and Keller, {Roberta L.} and Rui Feng and DeMauro, {Sara B.} and Thomas Ferkol and William Hardie and Rogers, {Elizabeth E.} and Stevens, {Timothy P.} and Voynow, {Judith A.} and Bellamy, {Scarlett L.} and Shaw, {Pamela A.} and Moore, {Paul E.} and Barbara Alexander and Claire Chougnet and Tari Gratton and Greenberg, {James M.} and Cathy Grisby and Jobe, {Alan H.} and Beth Koch and Karen McDowell and Kelly Thornton and Pamela Bates and Claudia Cleveland and Aaron Hamvas and Julie Hoffmann and Holland, {Mark R.} and James Kemp and Levy, {Philip T.} and Laura Linneman and Jayne Sicard-Su and Gina Simpson and Singh, {Gautam K.} and Barbara Warner and Ballard, {Philip L.} and Ballard, {Roberta A.} and Durand, {David J.} and Eichenwald, {Eric C.} and Khan, {Amir M.} and Leslie Lusk and Merrill, {Jeffrey D.} and Nielson, {Dennis W.} and Asselin, {Jeanette M.} and Samantha Balan and Katrina Burson and Cheryl Chapin and Erna Josiah-Davis and Carmen Garcia and Hart Horneman and Rick Hinojosa and Christopher Johnson and Susan Kelley",

note = "Publisher Copyright: {\textcopyright} 2017 Elsevier Inc.",

year = "2017",

month = aug,

doi = "10.1016/j.jpeds.2017.04.026",

language = "English (US)",

volume = "187",

pages = "89--97.e3",

journal = "journal of pediatrics",

issn = "0022-3476",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age

T2 - A Prospective Cohort Study

AU - for the

AU - Keller, Roberta L.

AU - Feng, Rui

AU - DeMauro, Sara B.

AU - Ferkol, Thomas

AU - Hardie, William

AU - Rogers, Elizabeth E.

AU - Stevens, Timothy P.

AU - Voynow, Judith A.

AU - Bellamy, Scarlett L.

AU - Shaw, Pamela A.

AU - Moore, Paul E.

AU - Alexander, Barbara

AU - Chougnet, Claire

AU - Gratton, Tari

AU - Greenberg, James M.

AU - Grisby, Cathy

AU - Jobe, Alan H.

AU - Koch, Beth

AU - McDowell, Karen

AU - Thornton, Kelly

AU - Bates, Pamela

AU - Cleveland, Claudia

AU - Hamvas, Aaron

AU - Hoffmann, Julie

AU - Holland, Mark R.

AU - Kemp, James

AU - Levy, Philip T.

AU - Linneman, Laura

AU - Sicard-Su, Jayne

AU - Simpson, Gina

AU - Singh, Gautam K.

AU - Warner, Barbara

AU - Ballard, Philip L.

AU - Ballard, Roberta A.

AU - Durand, David J.

AU - Eichenwald, Eric C.

AU - Khan, Amir M.

AU - Lusk, Leslie

AU - Merrill, Jeffrey D.

AU - Nielson, Dennis W.

AU - Asselin, Jeanette M.

AU - Balan, Samantha

AU - Burson, Katrina

AU - Chapin, Cheryl

AU - Josiah-Davis, Erna

AU - Garcia, Carmen

AU - Horneman, Hart

AU - Hinojosa, Rick

AU - Johnson, Christopher

AU - Kelley, Susan

PY - 2017/8

Y1 - 2017/8

N2 - Objective To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs). Study design We enrolled ELGANs (<29 weeks’ gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks’ postmenstrual age. We surveyed caregivers at 3, 6, 9, and 12 months’ corrected age to identify postdischarge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheostomy, ventilation), medications, or symptoms (cough/wheeze). Infants were classified as having postprematurity respiratory disease (PRD, the primary study outcome) if respiratory morbidity persisted over ≥2 questionnaires. Infants were classified with severe respiratory morbidity if there were multiple hospitalizations, exposure to systemic steroids or pulmonary vasodilators, home oxygen after 3 months or mechanical ventilation, or symptoms despite inhaled corticosteroids. Mixed-effects models generated with data available at 1 day (perinatal) and 36 weeks’ postmenstrual age were assessed for predictive accuracy. Results Of 724 infants (918 ± 234 g, 26.7 ± 1.4 weeks’ gestational age) classified for the primary outcome, 68.6% had PRD; 245 of 704 (34.8%) were classified as severe. Male sex, intrauterine growth restriction, maternal smoking, race/ethnicity, intubation at birth, and public insurance were retained in perinatal and 36-week models for both PRD and respiratory morbidity severity. The perinatal model accurately predicted PRD (c-statistic 0.858). Neither the 36-week model nor the addition of bronchopulmonary dysplasia to the perinatal model improved accuracy (0.856, 0.860); c-statistic for BPD alone was 0.907. Conclusion Both bronchopulmonary dysplasia and perinatal clinical data accurately identify ELGANs at risk for persistent and severe respiratory morbidity at 1 year. Trial registration ClinicalTrials.gov: NCT01435187.

AB - Objective To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs). Study design We enrolled ELGANs (<29 weeks’ gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks’ postmenstrual age. We surveyed caregivers at 3, 6, 9, and 12 months’ corrected age to identify postdischarge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheostomy, ventilation), medications, or symptoms (cough/wheeze). Infants were classified as having postprematurity respiratory disease (PRD, the primary study outcome) if respiratory morbidity persisted over ≥2 questionnaires. Infants were classified with severe respiratory morbidity if there were multiple hospitalizations, exposure to systemic steroids or pulmonary vasodilators, home oxygen after 3 months or mechanical ventilation, or symptoms despite inhaled corticosteroids. Mixed-effects models generated with data available at 1 day (perinatal) and 36 weeks’ postmenstrual age were assessed for predictive accuracy. Results Of 724 infants (918 ± 234 g, 26.7 ± 1.4 weeks’ gestational age) classified for the primary outcome, 68.6% had PRD; 245 of 704 (34.8%) were classified as severe. Male sex, intrauterine growth restriction, maternal smoking, race/ethnicity, intubation at birth, and public insurance were retained in perinatal and 36-week models for both PRD and respiratory morbidity severity. The perinatal model accurately predicted PRD (c-statistic 0.858). Neither the 36-week model nor the addition of bronchopulmonary dysplasia to the perinatal model improved accuracy (0.856, 0.860); c-statistic for BPD alone was 0.907. Conclusion Both bronchopulmonary dysplasia and perinatal clinical data accurately identify ELGANs at risk for persistent and severe respiratory morbidity at 1 year. Trial registration ClinicalTrials.gov: NCT01435187.

KW - prematurity

KW - pulmonary morbidity

KW - wheeze

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UR - http://www.scopus.com/inward/citedby.url?scp=85020088554&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2017.04.026

DO - 10.1016/j.jpeds.2017.04.026

M3 - Article

C2 - 28528221

AN - SCOPUS:85020088554

SN - 0022-3476

VL - 187

SP - 89-97.e3

JO - journal of pediatrics

JF - journal of pediatrics

ER -

Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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