Predicting death or tracheostomy placement in infants with severe bronchopulmonary dysplasia

    Authors

    K. Murthy; R. C. Savani; J. M. Lagatta; I. Zaniletti; R. Wadhawan; W. Truog; T. R. Grover; H. Zhang; J. M. Asselin; D. J. Durand; B. L. Short; E. K. Pallotto; M. A. Padula; F. D. Dykes; K. M. Reber;J. R. Evans

    Comments

    Authors: contact us about adding a copy of your work at STARS@ucf.edu

    Abbreviated Journal Title

    J. Perinatol.

    Keywords

    neonatal intensive care; pulmonary hypertension; bloodstream infection; corticosteroids; Children's Hospitals Neonatal Consortium (CHNC); Children's Hospitals Neonatal Database; BIRTH-WEIGHT INFANTS; CHRONIC LUNG-DISEASE; PHYSIOLOGICAL DEFINITION; PULMONARY-HYPERTENSION; PREMATURE-INFANTS; PRETERM INFANTS; INTENSIVE-CARE; NEONATAL CARE; IMPACT; OUTCOMES; Obstetrics & Gynecology; Pediatrics

    Abstract

    OBJECTIVE: To estimate the risk of death or tracheostomy placement (D/T) in infants with severe bronchopulmonary dysplasia (sBPD) born < 32 weeks' gestation referred to regional neonatal intensive care units. STUDY DESIGN: We conducted a retrospective cohort study in infants born < 32 weeks' gestation with sBPD in 2010-2011, using the Children's Hospital Neonatal Database. sBPD was defined as the need for FiO(2) > = 0.3, nasal cannula support > 2 l min(-1) or positive pressure at 36 weeks' post menstrual age. The primary outcome was D/T before discharge. Predictors associated with D/T in bivariable analyses (P < 0.2) were used to develop a multivariable logistic regression equation using 80% of the cohort. This equation was validated in the remaining 20% of infants. RESULT: Of 793 eligible patients, the mean gestational age was 26 weeks' and the median age at referral was 6.4 weeks. D/T occurred in 20% of infants. Multivariable analysis showed that later gestational age at birth, later age at referral along with pulmonary management as the primary reason for referal, mechanical ventilation at the time of referral, clinically diagnosed pulmonary hypertension, systemic corticosteroids after referral and occurrence of a bloodstream infection after referral were each associated with D/T. The model performed well with validation (area under curve 0.86, goodness-of-fit chi(2), P = 0.66). CONCLUSION: Seven clinical variables predicted D/T in this large, contemporary cohort with sBPD. These results can be used to inform clinicians who counsel families of affected infants and to assist in the design of future prospective trials.

    Journal Title

    Journal of Perinatology

    Volume

    34

    Issue/Number

    7

    Publication Date

    1-1-2014

    Document Type

    Article

    Language

    English

    First Page

    543

    Last Page

    548

    WOS Identifier

    WOS:000338226300010

    ISSN

    0743-8346

    Share

    COinS