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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 79-97 |
| Number of pages | 19 |
| Journal | American journal of respiratory and critical care medicine |
| Volume | 208 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 1 2023 |
Funding
Supported by NHLBI, NIH, grants U01 HL133708, U01 HL133643, U01 HL133704, U01 HL133536, U01 HL133689, and U01 HL133700. The NIH and the NHLBI provided grant support through cooperative agreements. This research was supported in part by the Intramural Research Program of the NIH and NHLBI. Although NHLBI staff did have input into the study design, conduct, analysis, and manuscript drafting, the content and views expressed in this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or the U.S. Department of Health and Human Services.
Keywords
- apnea
- bronchopulmonary dysplasia
- extremely premature infant
- heart rate
- intermittent hypoxemia
- predictive value of tests
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine