Is the new definition of bronchopulmonary dysplasia more useful?

OBJECTIVE: To determine the incidence of bronchopulmonary dysplasia (BPD) in low birth weight (LBW) infants <1251 g managed with early bubble nasal continuous positive airway pressure (NCPAP) and a gentle ventilation strategy using the newly proposed definition for BPD and the previous definitions. METHODS: Needs for supplemental oxygen and positive pressure (positive pressure ventilation or NCPAP) during initial hospitalization were evaluated in 266 inborn LBW infants (birth weight <1251 g). The data were categorized in three weight groups, <751, 751 to 1000 and 1001 to 1250 g and the incidence of BPD was computed in survivors based on oxygen need at 28 days, 36 weeks postmenstrual age (PMA) and the new severity of BPD criteria, that is, mild BPD: need for supplemental oxygen > or =28 days, but not at 36 weeks PMA; moderate BPD: need for supplemental oxygen > or =28 days and <30% at 36 weeks PMA and severe BPD: need for supplemental oxygen > or =28 days, and >30% at 36 weeks PMA and/or positive pressure at 36 weeks PMA. Further, BPD-associated comorbidities and short-term outcome data during hospitalization were compared among the groups, defined by severity of BPD. RESULTS: Among LBW infants <1251 g, the incidences of BPD at 28 days and 36 weeks PMA were 21.1 and 7.4% respectively. Using the newly defined criteria, the incidences of mild, moderate and severe BPD were 13.5, 4.8 and 2.6%, respectively. In total, 64.6% of these infants had mild BPD and 70.8% weighed <751 g at birth. Associated comorbidities correlated significantly with grades of underlying pulmonary disease. Also, significantly longer hospital stay, discharge at a higher PMA and lower growth velocity was observed with increasing grades of BPD. CONCLUSIONS: The new system for grading the severity of BPD offers a better description of underlying pulmonary disease and correlates with the infant's maturity, growth and overall severity of illness. Whether it will have a role in predicting long-term outcome remains to be determined.

Is mechanical ventilation associated with intraventricular hemorrhage in preterm infants?

BACKGROUND: The impact of mechanical ventilation on the incidence of intraventricular hemorrhage (IVH) in very low birth weight (VLBW) infants is unknown, simply because the vast majority of these infants have been routinely intubated and mechanically ventilated. There is a growing interest in the use of early nasal continuous positive airway pressure (ENCPAP) and avoiding mechanical ventilation. OBJECTIVES: To examine the role of mechanical ventilation since delivery room in determining severe IVH in VLBW infants in two neonatal units that follow the same strategy of respiratory management using ENCPAP. METHODS: We collected data on delivery room intubation and mechanical ventilation during the first 3 days of life in VLBW infants. Logistic regression model was constructed to test the relationship between early mechanical ventilation and the diagnosis of severe IVH after controlling for significant confounding variables, such as BW, gender, duration of mechanical ventilation, and partial pressure of CO(2) (PCO(2)). RESULTS: Of the studied 340 VLBW, 35 infants had severe IVH; most of them received mechanical ventilation that started either in the delivery room (n=12) or during the first (n=10) and second (n=3) days of life. Severe IVH was independently associated with lower BW, mechanical ventilation in the delivery room, and the cumulative duration of mechanical ventilation during the first 3 days. The adjusted odds ratio for severe IVH in infants intubated in delivery room was (OR=2.7, CI: 1.1-6.6, P=0.03). Severe IVH was not associated with gender, prenatal steroids, early sepsis, or patent ductus arteriosus. CONCLUSIONS: Mechanical ventilation plays a role in predicting severe IVH. Both the time at which ventilation was initiated and the duration of ventilation are important determinants of severe IVH. Risk for severe IVH in infants who were never intubated in delivery room or during the first 3 days of life is miniscule.