Long-Term Pulmonary and Neurodevelopmental Outcomes of Meconium Aspiration Syndrome Affected Infants: A Retrospective National Population-Based Study in Taiwan.

INTRODUCTION: Meconium aspiration syndrome (MAS) may cause severe pulmonary and neurologic injuries in affected infants after birth, leading to long-term adverse pulmonary or neurodevelopmental outcomes. METHODS: This retrospective population-based cohort study enrolled 1,554,069 mother-child pairs between 2004 and 2014. A total of 8,049 infants were in the MAS-affected group, whereas 1,546,020 were in the healthy control group. Children were followed up for at least 3 years. According to respiratory support, MAS was classified as mild, moderate, and severe. With the healthy control group as the reference, the associations between MAS severity and adverse pulmonary outcomes (hospital admission, intensive care unit (ICU) admission, length of hospital stay, or invasive ventilator support during admission related to pulmonary problem) or adverse neurodevelopmental outcomes (cerebral palsy, needs for rehabilitation, visual impairment, or hearing impairment) were accessed. RESULTS: MAS-affected infants had a higher risk of hospital and ICU admission and longer length of hospital stay, regardless of severity. Infants with severe MAS had a higher risk of invasive ventilator support during re-admission (odds ratio: 17.50, 95% confidence interval [CI]: 7.70-39.75, p < 0.001). Moderate (hazard ratio [HR]: 1.66, 95% CI: 1.30-2.13, p < 0.001) and severe (HR: 4.94, 95% CI: 4.94-7.11, p < 0.001) MAS groups had a higher risk of adverse neurodevelopmental outcome, and the statistical significance remained remarkable in severe MAS group after adjusting for covariates (adjusted HR: 2.28, 95% CI: 1.54-3.38, p < 0.001) Conclusions: Adverse pulmonary or neurodevelopmental outcomes could occur in MAS-affected infants at birth. Close monitoring and follow-up of MAS-affected infants are warranted.

Maternal, Perinatal, and Postnatal Predisposing Factors of Hearing Loss in Full-Term Children: A Matched Case-Control Study.

INTRODUCTION: Studies on risk factors for childhood hearing loss (HL) are usually based on questionnaires or small sample sizes. We conducted a nationwide population-based case-control study to comprehensively analyze the maternal, perinatal, and postnatal risk factors for HL in full-term children. METHODS: We retrieved data from three nationwide databases related to maternal characteristics, perinatal comorbidities, and postnatal characteristics and adverse events. We used 1:5 propensity score matching to include 12,873 full-term children with HL and 64,365 age-, sex-, and enrolled year-matched controls. Conditional logistic regression was used to evaluate the risk factors for HL. RESULTS: Among the various maternal factors, maternal HL (adjusted odds ratio [aOR]: 8.09, 95% confidence interval [95% CI]: 7.16-9.16) and type 1 diabetes (aOR: 3.79, 95% CI: 1.98-7.24) had the highest odds of childhood hearing impairment. The major perinatal risk factors for childhood hearing impairment included ear malformations (aOR: 58.78, 95% CI: 37.5-92.0) and chromosomal anomalies (aOR: 6.70, 95% CI: 5.25-8.55), and the major postnatal risk factors included meningitis (aOR: 2.08, 95% CI: 1.18-3.67) and seizure (aOR: 3.71, 95% CI: 2.88-4.77). Other factors included acute otitis media, postnatal ototoxic drug use, and congenital infections. CONCLUSIONS: Many risk factors for childhood HL identified in our study are preventable, such as congenital infection, meningitis, ototoxic drug use, and some maternal comorbidities. Accordingly, more effort is required to prevent and control the severity of maternal comorbidities during pregnancy, initiate genetic diagnostic evaluation for high-risk children, and aggressive screening for neonatal infections.

Maternal and neonatal risk factors of asthma in children: Nationwide population based study.

BACKGROUND: Small population group-based cohorts have found that perinatal factors may contribute to the development of asthma in children. We aimed to investigate maternal and neonatal risk factors for the asthma phenotypes using two databases from the Taiwan's Maternal and Child Health Database (TMCHD) and the National Health Insurance Research Database (NHIRD). METHODS: Perinatal data was obtained from 2004 to 2008 in the TMCHD and linked the NHIRD to obtain relevant medical information regarding maternal and neonatal risk factors of three asthma phenotypes which were identified as transient early asthma, persistent asthma, and late-onset asthma. A multivariate logistic regression analysis was conducted to adjust for covariates. RESULTS: The percentage of non-asthmatic patients was 77.02% and asthmatic (transient early asthma, late onset asthma, and persistent asthma) patients were 8.96%, 11.64%, and 2.42%, respectively. Maternal risk factors-including Cesarean section, maternal asthma, maternal allergic rhinitis (AR), and premature rupture of membranes-and neonatal risk factors, such as male gender, gestational age 29-37 weeks, ventilator use, antibiotics use, AR, and atopic dermatitis, were associated with the development of these three asthma phenotypes. Twins and a gestational age of 28 weeks or less premature were associated with the development of transient early asthma and persistent asthma, but not late onset asthma. Triplets and above were associated with the development of transient early asthma, but not late onset or persistent asthma. CONCLUSION: Various asthma phenotypes have different risk factors; therefore, their distinct risk factors should be identified in order to early diagnosis and treatment.

Adjuvant probiotic Bifidobacterium animalis subsp. lactis CP-9 improve phototherapeutic treatment outcomes in neonatal jaundice among full-term newborns: A randomized double-blind clinical study.

BACKGROUND: Probiotics had been used to decreased bilirubin level in neonatal jaundice (NJ) without being further studied mechanism and stratification. The intestinal pathogen Escherichia coli produced ß-glucuronidase would increase enterohepatic circulation and elevate serum bilirubin levels (SBLs) which might worsen the disease process of NJ. STUDY OBJECTIVE: We hypothesized that some probiotics could decrease bilirubin level through inhibiting the growth of E. coli. It's assumed that adjuvant probiotic intervention might accelerate the phototherapy for NJ and alleviate the severity of the NJ. Besides, it's further study the efficacy of the probiotic intervention in NJ among the full-term and preterm newborns. MATERIALS AND METHODS: Firstly, the Bifidobacterium animalis subsp. lactis CP-9 was screened for its anti-E. coli activity. Then, it was orally administered to newborns with NJ in combination with conventional phototherapy (wavelength 425-457 nm) to determine its efficacy. 83 neonatal patients whose serum bilirubinemia was at a concentration of ≥ 15 mg/dL were participated the double-blind randomized trial and conducted in the neonatal ward of China Medical University Children's Hospital (CMUCH, Taichung, Taiwan). The test was conducted in 2 groups: experimental group: phototherapy + B. animalis subsp. lactis CP-9 (n = 43; 5 × 109 CFU/capsule) and control group: phototherapy + placebo (n = 40). The SBL and total phototherapy duration were measured. RESULTS: The experimental group showed improved serum bilirubin decline rate (-0.16 ±â€…0.02 mg/dL/h; P = .009, 95% CI -0.12 to -0.2), particularly in the first 24 hour of in-hospital care, and reduced total phototherapy duration (44.82 ±â€…3.23 h; P = .011, 95% CI: 51.3-38.2) compared with the control group. Especially, probiotics had a significant therapeutic effect (serum bilirubin decline rate: -0.18 ±â€…0.02 mg/dL/h, 95% CI -0.12 to -0.23, P = .014; phototherapy duration: 43.17 ±â€…22.72 h, 95% CI 51.9-34.3, P = .019) in the low-risk subgroup (full-term newborns). CONCLUSIONS: In conclusion, B. animalis subsp. lactis CP-9 synergistically improves treatment outcomes of NJ during in-hospital phototherapy including reduced total phototherapy duration and improved serum bilirubin decline rate, particularly in full-term newborns.

Epidemiological evolution of early-onset neonatal sepsis over 12 years: A single center, population-based study in central Taiwan.

BACKGROUND: We aimed to explore the epidemiology and evolution of pathogens, antibiotic susceptibility, and mortality rate in cases of neonatal early-onset sepsis (EOS) reported over a period of 12 years in a level III neonatal center in Central Taiwan. METHODS: Patients' medical records in a neonatal center from 2007 to 2018 were reviewed to obtain information on infants with culture-proven EOS, which included pathogens found in the blood or cerebrospinal fluid cultures. RESULTS: The incidence of neonatal EOS during this period was 2.11 cases/1,000 admissions. Group B streptococcal (GBS) and Escherichia coli were the most common pathogens. The overall rates of GBS and E. coli infections were 0.68/1,000 and 0.77/1,000 live births, respectively. The incidence of EOS in infants with a birth weight ≥1,500 g decreased significantly with decreasing incidence of GBS-related sepsis. The incidence of EOS remained high in very-low-birth-weight (VLBW) infants and increased over time. There was an increasing trend in of E. coli infection and emergence of drug-resistant strains. In addition, E. coli sepsis had high mortality in VLBW infants. CONCLUSION: Novel screening and prevention strategies against E. coli and reserving broad-spectrum antibiotics for the most critically ill or VLBW patients with maternal chorioamnionitis might help in early diagnosis and further improve the outcomes of EOS.

Evidence base multi-discipline critical strategies toward better tomorrow for very preterm infants.

Despite advances in neonatal intensive care in the recent decade, a large number of very preterm infants (VPIs) remain at risk for significant neurodevelopmental impairment (NDI). Given that there are many interventions need to be implemented during the critical perinatal period so that complications of these vulnerable VPIs could be minimized, it is urgent to develop multi-discipline strategies based on evidence to be carried out. The objective of this new term evidence-based perinatal critical strategies (EBPCS), is to provide beneficial intervention towards better neurodevelopmental outcomes, specifically for preterm infants below 28 weeks gestational age. EBPCS is defined as the management of the VPIs during the perinatal period which would include antenatal counseling with team briefing and share decision making, treat the chorioamnionitis, antenatal MgS04, antenatal steroid, delayed cord clamping/milking, neonatal resuscitation team preparation, prevention of hypothermia, immediate respiratory support with continuous positive airway pressure at delivery room, less invasive surfactant administration, early surfactant with budesonide therapy, support of cardiovascular system, early initiate of probiotics administration, early caffeine, early parenteral and enteral nutrition, promptly initiating antibiotics. These critical strategies will be discussed detail in the text; nonetheless, standardized protocols, technical skills and repeated training are the cornerstones of successful of EBPCS. Further experience from different NICU is needed to prove whether these very complicate and comprehensive perinatal critical strategies could translate into daily practice to mitigate the incidence of NDI in high-risk VPIs.

Therapeutic strategy of patent ductus arteriosus in extremely preterm infants.

The ductus arteriosus is likely to close without treatment in most infants born at gestational age (GA) > 28 weeks (73%), and those with birth weight > 1000 g (94%). However, the rates of spontaneous ductal closure among less mature or smaller infants with respiratory distress syndrome are not known. Extremely preterm infants born at GA < 28 weeks are associated with a high risk of severe intraventricular hemorrhage (IVH) or pulmonary hemorrhage, which usually occur within 72 h after birth and affect mortality and long-term neurological development. These serious hemorrhagic complications may be closely related to hemodynamic changes caused by a hemodynamically significant patent ductus arteriosus (hs-PDA). While prophylactic indomethacin has been shown to reduce the rates of PDA, PDA ligation, severe IVH and early pulmonary hemorrhage, the available evidence does not support its prophylactic use in preterm infants. Symptomatic or late treatment is associated with lower success rate, and increased complications of a hs-PDA. The issue of "to treat or not to treat a PDA" is controversial. Considering the relationship between the effectiveness and timing of pharmacological treatment, early targeted treatment may be an alternative approach for the early identification of a hs-PDA in specific high-risk patient population, especially infants <26 weeks GA who are at the highest risk of severe IVH or pulmonary hemorrhage. Serial echocardiographic studies can be used to select patients who are candidates for early targeted medical treatment of hs-PDA. Surgical ligation of PDA, and transcatheter closure if proven to be safe, can be used as back-up therapy for patients who fail medical treatment and continue to have cardiopulmonary compromise.

IGF1R+ Dental Pulp Stem Cells Enhanced Neuroplasticity in Hypoxia-Ischemia Model.

Until now, the surface markers of multipotent mesenchymal stem cells (MSCs) had not been fully identified. Here, we found that the IGF1 receptor (IGF1R), regarded as a pluripotent marker of embryonic stem cells (ESCs), was also expressed in human dental pulp derived-mesenchymal stem cells (hDSCs), which displayed a potential for both self-renewal and multipotency. hDSC-secreted IGF1 interacted with IGF1R through an autocrine signaling pathway to maintain this self-renewal and proliferation potential. Stereotaxic implantation of immunosorted IGF1R+ hDSCs in rats with neonatal hypoxia-ischemia (NHI) promoted neuroplasticity, improving the neurological outcome by increasing expression of the anti-apoptotic protein Bcl-2, which enhanced both neurogenesis and angiogenesis. In addition, treatment with IGF1R+ hDSCs significantly modulated neurite regeneration and anti-inflammation in vivo in NHI rats and in vitro in primary cortical cultures under oxygen/glucose deprivation. Autocrine regulatory expression of IGF1R contributed to maintaining the self-renewal capacity of hDSCs. Furthermore, implantation of IGF1R+ hDSCs increased neuroplasticity with neurite regeneration and immunomodulation in and the NHI rat model.

Efficacy of different probiotic combinations on death and necrotizing enterocolitis in a premature rat model.

OBJECTIVE: The aim of the present study was to investigate the most effective probiotic combinations to prevent death and necrotizing enterocolitis (NEC) in a premature rat model. METHODS: One hundred fifty-eight premature Sprague-Dawley premature rats were enrolled. Probiotic strains Bifidobacterium bifidum, B longum, Lactobacillus acidophilus, L plantarum, and B breve were fed as a single strain or mixture with 2 or 3 strains for a total of 9 study groups; control groups received no exogenous probiotic supplement. Fecal samples were collected for 72 hours to detect probiotic strains and pathologic strains by real-time polymerase chain reaction. Colony counts of probiotic strains Escherichia coli and Klebsiella were compared between groups before and after 36 hours of the study period. The incidence of death and NEC were compared via Fisher exact test between groups. RESULTS: The results demonstrated that L plantarum alone (P = 0.0026) and B bifidum with B longum together (P = 0.0017) were more effective in reducing NEC as compared with the control group. All of the study groups except B breve and B bifidum with B breve definitely prevented death compared with controls. B bifidum and B longum together had significantly lower mortality than the control group (P < 0.0001). Colony counts of E coli and Klebsiella in stool samples were significantly decreased in the B bifidum, B longum, and L plantarum group compared with the other study and control groups after 36 hours. CONCLUSIONS: Administration of a mixture of probiotic strains with B bifidum and B longum was most effective in preventing death and NEC in this animal model, and these observations provide an evidence-based strategy for designing further neonatal clinical trials.

Efficacy of creamatocrit technique in evaluation of premature infants fed with breast milk.

BACKGROUND: Most premature babies are discharged with low body weight. Creamatocrit represents the lipid concentration of breast milk. We expected the creamatocrit technique could be applied in the nutrition plan for premature infants who were exclusively fed by human milk. METHODS: Breast milk samples were obtained from the mothers whose babies were admitted to the neonatal intensive care unit or sick baby room. The breast milk provider was enrolled under the criteria of stable breast milk expression 2 weeks after having given birth. Breast milk was collected for 7 consequent days. Creamatocrit technique and calorie analysis were performed on the processed breast milk samples. RESULTS: Fourteen pairs of mothers and infants were enrolled in our study. The median gestational age and birth weight were 29 weeks (27-36 weeks) and 1,393 g (680-3050 g), respectively. The mean calorie and creamatocrit values for all the 98 breast milk samples were 0.67 kcal/mL and 5.98%, respectively. The linear correlation between creamatocrit value and laboratory-measured calories was found to be calories (kcal/mL)=0.39+0.048×creamatocrit (%) (p<0.05). CONCLUSION: We established the relation equation of creamatocrit and calories for the first time in Chinese population, which is convenient and accurate for evaluating calories provided for premature infants fed with breast milk.

Neonatal intracranial aneurysm rupture treated by endovascular management: a case report.

Pediatric intracranial aneurysm rupture is rare, and is traditionally managed by surgical clipping. To the best of our knowledge, endovascular embolization of aneurysms in neonates has not previously been reported in Taiwan. We report a 9-day-old boy with intracranial aneurysms who underwent endovascular embolization, representing the youngest reported case in Taiwan. The 9-day-old boy presented with non-specific symptoms of irritable crying, seizure and respiratory distress. Computed tomography disclosed intraventricular hemorrhage, subarachnoid hemorrhage and focal intracranial hemorrhage around the right cerebellum. Subsequent computed tomographic angiography showed two sequential fusiform aneurysms, measuring 3 mm, located in the right side posterior inferior cerebellar artery (PICA). The patient underwent endovascular embolization because of the high risk of aneurysm re-rupture and the impossibility of surgical clipping due to the fusiform nature of the aneurysms. A postembolization angiogram revealed complete obliteration of the right distal PICA and proximal aneurysm. The distal PICA aneurysm was revascularized from the collateral circulation, but demonstrated a slow and delayed filling pattern. The patient's condition remained stable over the following week, and he was discharged without anticonvulsant therapy. No significant developmental delay was noted at follow-up at when he was 3 months old. This case emphasizes the need for clinical practitioners to consider a diagnosis of intracranial hemorrhage in neonates with seizure and increased intracranial pressure. Neonatal intracranial aneurysms can be treated safely by endovascular treatment.

Lack of effects of oral probiotics on growth and neurodevelopmental outcomes in preterm very low birth weight infants.

OBJECTIVE: To evaluate growth and neurodevelopmental outcomes in preterm very low birth weight (PVLBW) infants treated with oral probiotics for the prevention of necrotizing enterocolitis (NEC). STUDY DESIGN: A prospective follow-up study was performed in a cohort of PVLBW infants enrolled in a single center with a masked randomized control trial to evaluate the efficacy of oral probiotics in preventing NEC. Growth measures included weight, length, and head circumference. Neurologic and sensory performance was evaluated with standard techniques. Psychometric parameters were measured used the Bayley Scales of Infant Development II (BSID-II). The studies were performed at 3 years corrected age. The primary outcome was death or neurodevelopmental impairment. RESULTS: Of the 367 subjects enrolled in trial, 301 (89.9%) were evaluated (153 in the probiotics group and 148 in the control group). There were no significant differences in growth or in any of the neurodevelopmental and sensory outcomes between the 2 groups. CONCLUSIONS: Oral probiotics given to PVLBW infants at 1 week after birth to reduce the incidence of NEC did not affect growth and neurodevelopmental and sensory outcomes at 3 years corrected age.

Nosocomial infection in a neonatal intensive care unit: a prospective study in Taiwan.

BACKGROUND: We performed a prospective analysis to determine the prevalence of nosocomial infection and associated risk factors in our neonatal intensive care unit (NICU). METHODS: Data were collected prospectively on underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes at 9 am every day from November 2004 through October 2005. Prevalence of nosocomial infection and infection site definitions were according to the National Nosocomial Infections Surveillance system of the Centers for Disease Control and Prevention. RESULTS: Among 528 infants enrolled, 60 (11.4%) had 97 nosocomial infections. The survival rate was 92%. The prevalence of nosocomial infections was 17.5%: bloodstream infection, 4.7%, clinical sepsis, 6.3%, pneumonia, 5.1%, urinary tract infections (UTIs), 0.7%, surgical site infection, 0.7%. Intervention-associated infection rate: central intravascular catheter-associated bloodstream infection, 13.7%, TPN-associated bloodstream infection, 15.8%, ventilator-associated pneumonia, 18.6%, surgical site infection 13.7%, urinary catheter-associated UTI, 17.3%. Cut-off values of onset of central intravascular catheter-associated bloodstream infection and ventilator-associated pneumonia were 6 days and 10 days after intervention, respectively. Patients with a birth weight <1000 g (relative risk, 11.8, 95% confidence interval, 7.66-18.18; P < .001) were at the greatest risk for nosocomial infection. CONCLUSIONS: This study revealed the high prevalence of nosocomial infections in NICU patients, and the urgent need for a national surveillance and more effective prevention interventions.

Ulinastatin alone does not reduce caspase 3-mediated apoptosis in protease-positive Aeromonas hydrophilia-induced sepsis.

BACKGROUND/PURPOSE: To evaluate the effect of ulinastatin, a protease inhibitor, on survival and apoptosis in protease-positive Aeromonas hydrophilia (PPAH)-induced sepsis. METHODS: Thirty mice were randomly allocated to receive intraperitoneal injection of either phosphate buffered saline (PBS) (control mice, n = 10) or PPAH (PPAH mice, n = 20). After 30 minutes, control mice received an additional intraperitoneal PBS injection, 10 PPAH mice received intraperitoneal PBS injection (non-treated PPAH mice), and the remaining 10 PPAH mice received an intraperitoneal injection of ulinastatin (ulinastatin-treated PPAH mice). RESULTS: Survival at 24 hours was 100% in control mice, and 35% (p < 0.05) in PPAH mice; the survival rate in non-treated and ulinastatin-treated PPAH mice were 30% and 40% (p > 0.05), respectively. The thymus weight (mg) decreased significantly in PPAH mice (51.1 +/- 14.9) compared to control mice (69.7 +/- 14.4; p < 0.001); there was no difference between ulinastatin-treated (52 +/- 13.9; p > 0.05) and non-treated PPAH mice (50.4 +/- 16). The thymus gland cell count reduced significantly in PPAH mice (8.1 +/- 4.7 x 10(7)) compared to control mice (12.8 +/- 6.6 x 10(7); p < 0.01), and immunofluorescence analysis demonstrated that the reduced cells were mostly CD4+ CD8+, in contrast to the increase in CD4+ CD8- cells. There was no difference in cell count between ulinastatin-treated (8.7 +/- 4.9 x 10(7)) and non-treated PPAH mice (7.4 +/- 4.6 x 10(7); p > 0.05). Caspase 3-mediated apoptosis was not detectable in control mice in contrast to the pronounced manifestation in PPAH mice. CONCLUSION: PPAH-induced sepsis has a high mortality that is related to lymphocyte apoptosis. Ulinastatin alone does not significantly reduce caspase 3-mediated lymphocyte apoptosis.

Interleukin-8 in bronchoalveolar lavage fluid of premature infants at risk of chronic lung disease.

BACKGROUND AND PURPOSE: Persistence of neutrophils in the tracheal fluid of premature infants is associated with chronic lung disease (CLD). Interleukin-8 (IL-8) is a potent neutrophil chemoattractant. This study investigated whether IL-8 is increased in the bronchoalveolar lavage fluid of premature infants with different types of CLD. METHODS: Forty two very low birth weight infants who required mechanical ventilation were recruited. Twenty eight of these infants developed CLD and 14 infants recovered without developing CLD. Four additional infants receiving mechanical ventilation for non-respiratory reasons were also enrolled as controls. CLD was defined as requirement for supplemental oxygen at 28 days of age and chest radiograph showing characteristic appearance. CLD was further classified into 3 subtypes: bronchopulmonary dysplasia (BPD), Wilson-Mikity syndrome (WMS) and chronic pulmonary insufficiency of prematurity (CPIP). RESULTS: IL-8 in bronchoalveolar lavage fluid was significantly increased in the CLD group by 8 days of age compared to those who did not develop CLD (p < 0.05). For infants without CLD, IL-8 increased from 963 pg/mL on day 1 after delivery to 1463 pg/mL on day 4, and decreased to 1,000 pg/mL on day 8. For infants with BPD, IL-8 increased from 925 pg/mL on day 1 after delivery to 2,650 pg/mL on day 8, and then gradually decreased to 1,500 pg/mL on day 28. Infants with WMS had significantly higher IL-8 from the first day after delivery (4,567 pg/mL) than infants with BPD or CPIP and this difference persisted to age 28 days (2475 pg/mL). CONCLUSIONS: Persistent inflammation could be a major contributory factor in the development of CLD. The different patterns of response to inflammation in different types of CLD may have implications for the design of appropriate strategies to prevent and treat CLD.

Evaluation of the severity of chronic lung disease in premature infants by pulse oximeter.

Three parameters obtained by pulse oximeter were tested to assess the severity of chronic lung disease (CLD) in premature infants. The FiO2 required to keep oxygen saturation of 90% on pulse oximeter at rest condition was defined as FiO2Sp90. The value of oxygen saturation with a FiO2 of 0.21 at rest was defined as room air saturation. The percentage of the time duration that oxygen saturation exceeded 90% during the measurement with the FiO2Sp90 was defined as time-percentage of SpO2 > or = 90% with FiO2Sp90. These parameters were monitored for 60 minutes once weekly in very low birth weight infants for at least 4 weeks beginning at 34 weeks of postconceptional age. Thirty-four infants were enrolled; 13 of them had CLD. There were totally 57 measurements in 13 infants with CLD, and 84 measurements in 21 infants with no CLD. Values of each parameter significantly correlated with the FiO2 used during the measurement; the FiO2Sp90 had positive correlation with FiO2 (r = 0.991, p < 0.001), the room air saturation and time percentage of SpO2 > 90% with FiO2Sp90 had negative correlation (r = -0.975, p < 0.001 and r = -0.668, p < 0.05, respectively). In the serial measurements, room air saturation improved even after the FiO2Sp90 reached 0.21. Time-percentage of SpO2 > or = 90% with FiO2Sp90 showed increase with age even after the room air saturation reached over 90%. Therefore, room air saturation was more sensitive than FiO2Sp90, and the time-percentage of SpO2 > or = 90% with FiO2Sp90 was more sensitive than room air saturation in estimating the severity of CLD. For clinical use, FiO2Sp90 may be used as a guide for oxygen concentration required. Room air saturation may offer a criterion in deciding the need of further oxygen therapy, and time-percentage of Sp02 > or = 90% with FiO2Sp90 could be used to follow up the improvement of lung function, even after the oxygen therapy was discontinued.