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

Publication ,  Journal Article
Keller, RL; Feng, R; DeMauro, SB; Ferkol, T; Hardie, W; Rogers, EE; Stevens, TP; Voynow, JA; Bellamy, SL; Shaw, PA; Moore, PE ...
Published in: J Pediatr
August 2017

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.

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Published In

J Pediatr

DOI

EISSN

1097-6833

Publication Date

August 2017

Volume

187

Start / End Page

89 / 97.e3

Location

United States

Related Subject Headings

  • Prospective Studies
  • Prognosis
  • Pregnancy
  • Pediatrics
  • Morbidity
  • Male
  • Lung
  • Infant, Very Low Birth Weight
  • Infant, Newborn
  • Infant
 

Citation

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Keller, R. L., Feng, R., DeMauro, S. B., Ferkol, T., Hardie, W., Rogers, E. E., … Prematurity and Respiratory Outcomes Program, . (2017). Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study. J Pediatr, 187, 89-97.e3. https://doi.org/10.1016/j.jpeds.2017.04.026
Keller, Roberta L., Rui Feng, Sara B. DeMauro, Thomas Ferkol, William Hardie, Elizabeth E. Rogers, Timothy P. Stevens, et al. “Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study.J Pediatr 187 (August 2017): 89-97.e3. https://doi.org/10.1016/j.jpeds.2017.04.026.
Keller, Roberta L., et al. “Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study.J Pediatr, vol. 187, Aug. 2017, pp. 89-97.e3. Pubmed, doi:10.1016/j.jpeds.2017.04.026.
Keller RL, Feng R, DeMauro SB, Ferkol T, Hardie W, Rogers EE, Stevens TP, Voynow JA, Bellamy SL, Shaw PA, Moore PE, Prematurity and Respiratory Outcomes Program. Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study. J Pediatr. 2017 Aug;187:89-97.e3.
Journal cover image

Published In

J Pediatr

DOI

EISSN

1097-6833

Publication Date

August 2017

Volume

187

Start / End Page

89 / 97.e3

Location

United States

Related Subject Headings

  • Prospective Studies
  • Prognosis
  • Pregnancy
  • Pediatrics
  • Morbidity
  • Male
  • Lung
  • Infant, Very Low Birth Weight
  • Infant, Newborn
  • Infant