Antenatal determinants of bronchopulmonary dysplasia and late respiratory disease in preterm infants

Lindsey A. Morrow, Brandie D. Wagner, David Ingram, Brenda B. Poindexter, Kurt Schibler, C. Michael Cotten, John Dagle, Marci K. Sontag, Peter M. Mourani, Steven H. Abman

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Rationale: Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood. Objectives: To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, longitudinal study of 587 preterm infants with gestational age less than 34 weeks and birth weights between 500 and 1,250 g. Methods: Data collected included perinatal information and assessments during the neonatal intensive care unit admission and longitudinal follow-up by questionnaire until 2 years of age. Measurements and Main Results: After adjusting for covariates, we found that maternal smoking prior to preterm birth increased the odds of having an infant with BPD by twofold (P = 0.02). Maternal smoking was associated with prolonged mechanical ventilation and respiratory support during the neonatal intensive care unit admission. Preexisting hypertension was associated with a twofold (P = 0.04) increase in odds for BPD. Lower gestational age and birth weight z-scores were associated with BPD. Preterm infants who were exposed to maternal smoking had higher rates of late respiratory disease during childhood. Twenty-two percent of infants diagnosed with BPD and 34% of preterm infants without BPD had no clinical signs of late respiratory disease during early childhood. Conclusions: We conclude that maternal smoking and hypertension increase the odds for developing BPD after preterm birth, and that maternal smoking is strongly associated with increased odds for late respiratory morbidities during early childhood. These findings suggest that in addition to the BPD diagnosis at 36 weeks, other factors modulate late respiratory outcomes during childhood. We speculate that measures to reduce maternal smoking not only will lower the risk for preterm birth but also will improve late respiratory morbidities after preterm birth.

Original languageEnglish (US)
Pages (from-to)364-374
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume196
Issue number3
DOIs
StatePublished - Aug 1 2017

Fingerprint

Bronchopulmonary Dysplasia
Premature Infants
Premature Birth
Smoking
Mothers
Neonatal Intensive Care Units
Birth Weight
Gestational Age
Hypertension
Morbidity
Respiratory Rate
Artificial Respiration
Lung Diseases
Longitudinal Studies
Chronic Disease
Prospective Studies

Keywords

  • Bronchopulmonary dysplasia
  • Hypertensive disorders of pregnancy
  • Maternal smoking
  • Preeclampsia
  • Prematurity

ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Antenatal determinants of bronchopulmonary dysplasia and late respiratory disease in preterm infants. / Morrow, Lindsey A.; Wagner, Brandie D.; Ingram, David; Poindexter, Brenda B.; Schibler, Kurt; Cotten, C. Michael; Dagle, John; Sontag, Marci K.; Mourani, Peter M.; Abman, Steven H.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 196, No. 3, 01.08.2017, p. 364-374.

Research output: Contribution to journalArticle

Morrow, LA, Wagner, BD, Ingram, D, Poindexter, BB, Schibler, K, Cotten, CM, Dagle, J, Sontag, MK, Mourani, PM & Abman, SH 2017, 'Antenatal determinants of bronchopulmonary dysplasia and late respiratory disease in preterm infants', American Journal of Respiratory and Critical Care Medicine, vol. 196, no. 3, pp. 364-374. https://doi.org/10.1164/rccm.201612-2414OC
Morrow, Lindsey A. ; Wagner, Brandie D. ; Ingram, David ; Poindexter, Brenda B. ; Schibler, Kurt ; Cotten, C. Michael ; Dagle, John ; Sontag, Marci K. ; Mourani, Peter M. ; Abman, Steven H. / Antenatal determinants of bronchopulmonary dysplasia and late respiratory disease in preterm infants. In: American Journal of Respiratory and Critical Care Medicine. 2017 ; Vol. 196, No. 3. pp. 364-374.
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abstract = "Rationale: Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood. Objectives: To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, longitudinal study of 587 preterm infants with gestational age less than 34 weeks and birth weights between 500 and 1,250 g. Methods: Data collected included perinatal information and assessments during the neonatal intensive care unit admission and longitudinal follow-up by questionnaire until 2 years of age. Measurements and Main Results: After adjusting for covariates, we found that maternal smoking prior to preterm birth increased the odds of having an infant with BPD by twofold (P = 0.02). Maternal smoking was associated with prolonged mechanical ventilation and respiratory support during the neonatal intensive care unit admission. Preexisting hypertension was associated with a twofold (P = 0.04) increase in odds for BPD. Lower gestational age and birth weight z-scores were associated with BPD. Preterm infants who were exposed to maternal smoking had higher rates of late respiratory disease during childhood. Twenty-two percent of infants diagnosed with BPD and 34{\%} of preterm infants without BPD had no clinical signs of late respiratory disease during early childhood. Conclusions: We conclude that maternal smoking and hypertension increase the odds for developing BPD after preterm birth, and that maternal smoking is strongly associated with increased odds for late respiratory morbidities during early childhood. These findings suggest that in addition to the BPD diagnosis at 36 weeks, other factors modulate late respiratory outcomes during childhood. We speculate that measures to reduce maternal smoking not only will lower the risk for preterm birth but also will improve late respiratory morbidities after preterm birth.",
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AU - Cotten, C. Michael

AU - Dagle, John

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KW - Hypertensive disorders of pregnancy

KW - Maternal smoking

KW - Preeclampsia

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