Bronchopulmonary dysplasia in critically ill infants : incidence and predictive factors

Abstract

Background: In the past few decades, with increasing advances in neonatology, more preterm infants have survived. In developed countries, about 12% - 42% of surviving very low birth weight (VLBW) infants developed bronchopulmonary dysplasia (BPD). This chronic lung disease is a severe health burden for both the family and public health resources, and presents several challenges to clinicians and public health practitioners. In the Guangdong province of China, there is no reliable data and research on BPD.

Objective: This study aimed to assess the incidence and the epidemiological profile of BPD, as well as possible risk factors of BPD in a Guangdong provincial transportation network for critically ill neonates.

Methods: This was a retrospective cohort study. Data on all VLBW infants (birth weight ≤ 1500g) who were admitted to the neonatal intensive care unit (NICU) of Guangdong Provincial Women and Children’s Hospital (GDWCH) from Jan. 1st 2013 to Dec.31st 2013 were collected from medical records of GDWCH (n=168). The incidence rate of BPD was estimated, and associations with demographic characteristics, maternal characteristics and factors related to clinical practice were described and assessed by univariate analysis and multivariate regression analysis with stepwise (backward) method. At last, a logistic regression model was adopted to predict the potential risk factors for BPD.

Results: The incidence rate of BPD in VLBW infants in this transportation network for critically ill infants during the study period was 44.6 cases per 100 person-years [95% confidence interval (CI) 40.8 - 48.4 cases per 100 person-years] based on the National Institute of Child Health and Human Development’s (NICHD) definition of BPD. Overall, infants with gestational age (GA) < 30 weeks were more likely to develop BPD [adjusted odds ratio (OR) 4.64; 95% CI 1.97, 10.89], compared to the infants with GA ≥ 30 weeks. Infants diagnosed with asphyxia (adjusted OR 2.78; 95% CI 1.08, 7.18) and infants who received endotracheal tube (ETT) ventilation ≥ 1 day (adjusted OR 3.90; 95% CI 1.33, 11.39) also had higher risk of BPD. On the other hand, female infants were less likely to develop BPD than male infants (adjusted OR 0.37; 95% CI 0.16, 0.87). Predictors for the development of BPD were infants with GA < 30 weeks, male gender, asphyxia and ETT ventilation ≥ 1 day.

Conclusion: The results of this study suggest that the prevention of prematurity may contribute to a decrease in the incidence of BPD. Improvement on strategies of supplemental oxygen and mechanical ventilation could potentially lower risk in preterm infants. Further study could focus on clinical practice as well as administrative implementation on neonatology, in order to improve healthcare services.