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

for the

Research output: Contribution to journalArticle

41 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)89-97.e3
JournalJournal of Pediatrics
Volume187
DOIs
StatePublished - Aug 1 2017

Fingerprint

Bronchopulmonary Dysplasia
Gestational Age
Cohort Studies
Newborn Infant
Prospective Studies
Morbidity
Hospitalization
Oxygen
Tracheostomy
Insurance
Vasodilator Agents
Artificial Respiration
Cough
Intubation
Caregivers
Ventilation
Adrenal Cortex Hormones
Smoking
Steroids
Mothers

Keywords

  • prematurity
  • pulmonary morbidity
  • wheeze

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{9f63c3548dc5402990652d690ab47596,
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’ 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.",
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 Stephanie Davis",
year = "2017",
month = "8",
day = "1",
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 = "Mosby 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 - Davis, Stephanie

PY - 2017/8/1

Y1 - 2017/8/1

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

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

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

VL - 187

SP - 89-97.e3

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

ER -