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 - Prematurity and Respiratory Outcomes Program
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 - Kelley, Susan
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/8
Y1 - 2017/8
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
U2 - 10.1016/j.jpeds.2017.04.026
DO - 10.1016/j.jpeds.2017.04.026
M3 - Article
C2 - 28528221
AN - SCOPUS:85020088554
SN - 0022-3476
VL - 187
SP - 89-97.e3
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -