Factores de risco de displasia broncopulmonar em cinco unidades portuguesas de cuidados intensivos neonatais

Guimarães, Hercília; Rocha, Gustavo; Vasconcellos, Gabriela; Proença, Elisa; Carreira, Maria Luísa; Sossai, Maria do Rosário; Morais, Benvinda; Martins, Isabel; Rodrigues, Teresa; Severo, Milton

doi:10.1016/S0873-2159(15)30039-8

Article information

Resumo

A displasia broncopulmonar (DBP) é multifactorial. Prematuridade, doença da membrana hialina, oxigénio, ventilação mecânica, inflamação e canal arterial são alguns dos factores na sua patogénese

Objectivo: Avaliar a prevalência da DBP e seus factores de risco em cinco unidades portuguesas, para implementar boas práticas no tratamento deste doentes.

Material e métodos: 256 recém-nascidos (RN) com idade gestacional (IG) <30 semanas e/ou peso <1250g internados em cinco unidades portuguesas, entre 2004 e 2006, foram estudados. Foi recolhida a informação clínica dos processos. A DBP foi definida como a necessidade de oxigénio às 36 semanas de idade pós-conceptional.

Resultados: A prevalência da DBP foi de 12,9%. O seu risco diminuiu de 46% por semana de IG e de 39% por 100g de peso. O risco de DBP foi maior entre os RN com baixo peso (OR adj = 0,73, 95% CI=0,57-0,95), doença da membrane hialina grave (OR adj = 9,85, 95% CI=1,05-92,35), com sépsis (OR adj = 6,22, 95% CI=1,68-23,02), com maior duração de ventilação (42 vs 3 dias, respectivamente nos RN com e sem DBP, p<0,001) e maior duração de FiO2>;0,30 (85 vs 5 dias, respectivamente nos doentes com e sem DBP, p<0,001).

Comentários: Os factores de risco de DBP mais relevantes foram o baixo peso, a doença da membrana hialina grave, a duração da ventilação mecânica e da oxigenoterapia e a sépsis. A implementação das boas práticas para reduzir a lesão pulmonar nos RN deve ser dirigida para melhorar as práticas que reduzem estes factores de risco.

Rev Port Pneumol 2010; XVI (3): 419-430

Palavras-chave:

Displasia broncopulmonar

recém-nas-cidos pré-termo

unidades de cuidados intensivos neonatais

doença da membrana hialina

ventilação mecânica

oxigenoterapia

factores de risco

boas práticas

Abstract

The pathogenesis of bronchopulmonary dysplasia (BPD) is clearly multifactorial. Specific pathogenic risk factors are prematurity, respiratory distress, oxygen supplementation, mechanical ventilation (MV), inflammation, patent ductus arteriosus (PDA), etc.

Aim: To evaluate BPD prevalence and to identify risk factors for BPD in five Portuguese Neonatal Intensive Care Units in order to develop better practices the management of these newborns.

Material and methods: 256 very low birth weight infants with gestational age (GA) <30 weeks and/or birthweight (BW) <1250g admitted in five Portuguese NICUs, between 2004 and 2006 were studied. A protocol was filled in based on clinical information registered in the hospital charts. BPD was defined as oxygen dependency at 36 weeks of postconceptional age.

Results: BPD prevalence was 12.9% (33/256). BPD risk decreased 46% per GA week and of 39% per 100g BW. BPD risk was significantly higher among newborns with low BW (adj OR= 0.73, 95% CI=0.57-0.95), severe hyaline membrane disease (adj OR= 9.85, 95% CI=1.05-92.35), and those with sepsis (adj OR=6.22, 95% CI=1.68-23.02), those with longer duration on ventilatory support (42 vs 3 days, respectively in BPD and no BPD patients, p<0.001) and longer duration of FiO2>;0.30 (85 vs 5 days, respectively in BPD and no BPD patients, p<0.001).

Comments: The most relevant risk factors were low birth weight, severe hyaline membrane disease, duration of respiratory support and oxygen therapy, and nosocomial sepsis. The implementation of potentially better practices to reduce lung injury in neonates must be addressed to improve practices to decrease these risk factors.

Rev Port Pneumol 2010; XVI (3): 419-430

Key-words:

Bronchopulmonary dysplasia

preterm infants

neonatal intensive care

prematurity

hyaline membrane disease

mechanical ventilation

oxygen therapy

risk factors

better practices

Full text is only aviable in PDF

Bibliography

[1.]

I.R.S. Sosenko, E. Bancalari.

New developments in the presentation, pathogenesis, epidemiology and prevention of bronchopulmonary dysplasia.

The Newborn Lung Eduardo Bancalari, pp. 187-207

[2.]

H.L. Halliday, C.P. O´Neil.

What is the evidence for drug therapy in the prevention and management of bronchopulmonary dysplasia?.

The newborn lung. Neonatal questions and controversies, pp. 208-232

[3.]

R.A. Ehrenkranz, M.C. Walsh, B.R. Vohr, A.H. Jobe, L.L. Wright, A.A. Fanaroff, L.A. Wrage, K. Poole.

National Institutes of Child Health and Human Development Neonatal Research Network Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia.

Pediatrics, 116 (2005), pp. 1353-1360

http://dx.doi.org/10.1542/peds.2005-0249 | Medline

[4.]

W.H. Northway Jr., R.C. Rosan, D.Y. Porter.

Pulmonary disease following respirator therapy of hyaline-membrane disease.Bronchopulmonary dysplasia.

N Engl J Med, 276 (1967), pp. 357-368

http://dx.doi.org/10.1056/NEJM196702162760701 | Medline

[5.]

E. Bancalari, G.E. Abdenour, R. Feller, J. Gannon.

Bronchopulmonary dysplasia: clinical presentation.

J Pediatr, 95 (1979), pp. 819-823

Medline

[6.]

A.T. Shennan, M.S. Dunn, A. Ohlsson, K. Lennox, E.M. Hoskins.

Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period.

Pediatrics, 82 (1988), pp. 527-532

Medline

[7.]

A.H. Jobe, E. Bancalari.

Bronchopulmonary dysplasia.

Am J Respi Crit Care Med, 163 (2001), pp. 1723-1729

[8.]

H. MacDonald.

American Academy of Pediatrics. Committee on fetus and newborn.

Perinatal care at the threshold of viability. Pediatrics, 110 (2002), pp. 1024-1027

Medline

[9.]

J.L. Ballard, J.C. Khoury, K. Wedig, L. Wang, B.L. EilersWalsman, R. Lipp.

New ballard score, expanded to include extremely premature infants.

J Pediatr, 119 (1991), pp. 417-423

Medline

[10.]

A.J. Rudolph, C.A. Smith.

Idiopathic respiratory distress syndrome of the newborn.

J Pediatr, 57 (1960), pp. 905-921

[11.]

M.C. Walsh, R.M. Kliegman.

Necrotizing enterocolitis: treatment based on staging criteria.

Ped Clin N Am, 33 (1986), pp. 179-201

[12.]

An International Classification of Retinopathy of Prematurity.

Pediatrics, 74 (1984), pp. 127-133

Medline

[13.]

The International Classification of Retinopathy of Prematurity revisited.

International Committee for the Classification of Retinopathy of Prematurity.

Arch Ophthalmol, 123 (2005), pp. 991-999

http://dx.doi.org/10.1001/archopht.123.7.991 | Medline

[14.]

L.A. Papile, J. Burstein, R. Burstein.

Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birthweights less than 1500g.

J Pediatr, 92 (1978), pp. 529-534

Medline

[15.]

L. de Vries, J.M. Rennie.

Preterm brain injury.

Textbok of neonatology, 3th, pp. 1252--1270

[16.]

E. Bancalari, N. Claure, I.R. Sosenko.

Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition.

Semin Neonatol, 8 (2003), pp. 63-71

Medline

[17.]

M.C. Walsh, Q. Yao, P. Gettner, E. Hale, M. Collins, A. Hensman, R. Everette, N. Peters, N. Miller, G. Muran, K. Auten, N. Newman, G. Rowan, C. Grisby, K. Arnell, L. Miller, B. Ball, G. McDavid.

National Institute of Child Health and Human Development Neonatal Research Network.

Impact of a physiologic definition on bronchopulmonary dysplasia rates. Pediatrics, 114 (2004), pp. 1305-1311

http://dx.doi.org/10.1542/peds.2004-0204Article | Medline

[18.]

M. Walsh, W. Engle, A. Laptook, S.N. Kazzi, S. Buchter, M. Rasmussen, Q. Yao.

National Institute of Child Health and Human Development Neonatal Research Network. Oxygen delivery through nasal cannulae to preterm infants: can practice be improved?.

Pediatrics, 116 (2005), pp. 857-861

http://dx.doi.org/10.1542/peds.2004-2411 | Medline

[19.]

VLBW infants in Portugal. National Multicenter Study 1996-2000.

Portuguese Neonatal Network.

Bial Award of Clinical Medicine, (2002),

[20.]

A. Valcamonico, P. Accorsi, C. Sanzeni, P. Martelli, P. La Boria, A. Cavazza, T. Frusca.

Mid- and long-term outcome of extremely low birth weight (ELBW) infants: an analysis of prognostic factors.

Matern Fetal Neonatal Med, 20 (2007), pp. 465-471

[21.]

C.P. Speer.

Inflammation and bronchopulmonary dysplasia: a continuing story.

Semin Fetal Neonatal Med, 11 (2006), pp. 354-362

http://dx.doi.org/10.1016/j.siny.2006.03.004 | Medline

[22.]

C.L. Bose, C.E. Dammann, M.M. Laughon.

Bronchopulmonary dysplasia and inflammatory biomarkers in the premature neonate.

Arch Dis Child Fetal Neonatal Ed, 93 (2008), pp. F455-F461

http://dx.doi.org/10.1136/adc.2007.121327 | Medline

[23.]

P. Groneck, J. Schmale, V. Soditt, H. Stützer, B. GötzeSpeer, C.P. Speer.

Bronchoalveolar inflammation following airway infection in preterm infants with chronic lung disease.

Pediatr Pulmonol, 31 (2001), pp. 331-338

Medline

[24.]

D.G. Sweet, H.L. Halliday.

Modeling and remodeling of the lung in neonatal chronic lung disease: implications for therapy.

Treat Respir Med, 4 (2005), pp. 347-359

Medline

[25.]

G. Rocha, E. Proença, C. Quintas, T. Rodrigues, H. Guimarães.

Chorioamnionitis and lung damage in the extremely low birth weight infant.

Rev Port Pneumol, 3 (2007), pp. 745-754

[26.]

J.V. Been, L.J. Zimmermann.

Histologic chorioamnionitis and respiratory outcome in preterm infants.

Arch Dis Child Fetal Neonatal, (2009 Jan 8),

[26.]

L. Gortner, I. Reiss, A. Hilgendorff.

Bronchopulmonary dysplasia and intrauterine growth restriction.

Lancet, 368 (2006), pp. 28

http://dx.doi.org/10.1016/S0140-6736(06)68965-4 | Medline

[27.]

K.A. Marks, B. Reichman, A. Lusky.

Zmora E; Israel Neonatal Network.

Fetal growth and postnatal growth failure in very-low-birthweight infants. Acta Paediatr, 95 (2006), pp. 236-242

Medline

[28.]

L. Gortner, A. Hilgendorff, T. Bähner, M. Ebsen, I. Reiss, S. Rudloff.

Hypoxia-induced intrauterine growth retardation: effects on pulmonary development and surfactant protein transcription.

Biol Neonate, 88 (2005), pp. 129-135

http://dx.doi.org/10.1159/000085895 | Medline

[29.]

G. Kewitz, S. Wudel, H. Hopp, W. Hopfenmüller, M. Vogel, I. Roots.

Below median birth weight in appropriate-for-gestational-age preterm infants as a risk factor for bronchopulmonary dysplasia.

J Perinat Med, 36 (2008), pp. 359-364

http://dx.doi.org/10.1515/JPM.2008.056 | Medline

[30.]

D. Sweet, G. Bevilacqua, V. Carnielli, G. Greisen, R. Plavka, O. Didrik Saugstad, U. Simeoni, C.P. Speer, A. Valls-I-Soler, H. Halliday.

Working Group on Prematurity of the World Association of Perinatal Medicine.

European Association of Perinatal Medicine. European consensus guidelines on the management of neonatal respiratory distress syndrome. J Perinat Med, 35 (2007), pp. 175-186

http://dx.doi.org/10.1515/JPM.2007.048 | Medline

[31.]

K. Burch, W. Rhine, R. Baker, F. Litman, J.W. Kaempf, E. Schwarz, S. Sun, N.R. Payne, P.J. Sharek.

Implementing potentially better practices to reduce lung injury in neonates.

Pediatrics, 111 (2003), pp. e432-e436

Medline

[32.]

R. Ramanathan.

Optimal ventilatory strategies and surfactant to protect the preterm lungs.

Neonatology, 93 (2008), pp. 302-308

http://dx.doi.org/10.1159/000121456 | Medline

[33.]

R. Ramanathan, S. Sardesai.

Lung protective ventilatory strategies in very low birth weight infants.

J Perinatol, 28 (2008), pp. S41-S46

http://dx.doi.org/10.1038/jp.2008.49 | Medline

[34.]

K. Bohlin, B. Jonsson, A.S. Gustafsson.

Blennow M Continuous positive airway pressure and surfactant.

Neonatology, 93 (2008), pp. 309-315

http://dx.doi.org/10.1159/000121457 | Medline

[35.]

D. Patel, A. Greenough.

Does nasal CPAP reduce bronchopulmonary dysplasia (BPD)?.

Acta Paediatr, 97 (2008), pp. 1314-1317

http://dx.doi.org/10.1111/j.1651-2227.2008.00931.x | Medline

[36.]

O.D. Saugstad.

Take a breath–but do not add oxygen (if not needed).

Acta Paediatr, 96 (2007), pp. 798-800

http://dx.doi.org/10.1111/j.1651-2227.2006.00348.x | Medline

[37.]

O.D. Saugstad, S. Ramji, R.F. Soll, M. Vento.

Resuscitation of newborn infants with 21% or 100% oxygen: an updated systematic review and meta-analysis.

Neonatology, 94 (2008), pp. 176-182

http://dx.doi.org/10.1159/000143397 | Medline

[38.]

W. Tin, S. Gupta.

Optimum oxygen therapy in preterm babies.

Arch Dis Child Fetal Neonatal; Ed., 92 (2007), pp. F143-F147

http://dx.doi.org/10.1136/archdischild-2015-308707 | Medline

[39.]

STOP-ROP Multicenter Study Group.

Supplemental therapeutic oxygen for pretreshold retinopathy of prematurity (STOP-ROP), a randomized controlled trial.

I: Primary outcomes. Pediatrics, 105 (2000), pp. 295-310

Medline

[40.]

A. Sola.

Oxygen in neonatal anesthesia: friend or foe?.

Curr Opin Anaesthesiol, 21 (2008), pp. 332-339

http://dx.doi.org/10.1097/ACO.0b013e3282f8ad8d | Medline

[41.]

T.P. Stevens, E.W. Harrington, M. Blennow, R.F. Soll.

Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome.

Cochrane Database Syst Rev, 17 (2007), pp. CD003063

[42.]

W. Oh, B.B. Poindexter, R. Perritt, J.A. Lemons, C.R. Bauer, R.A. Ehrenkranz, B.J. Stoll, K. Poole, L.L. Wright.

Neonatal Research Network. Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants.

J Pediatr, 147 (2005), pp. 786-790

http://dx.doi.org/10.1016/j.jpeds.2005.06.039 | Medline

[43.]

B.E. Stephens, R.A. Gargus, R.V. Walden, M. Mance, J. Nye, L. McKinley, R. Tucker, B.R. Vohr.

Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants.

J Perinatol, 28 (2008), pp. 123-128

http://dx.doi.org/10.1038/sj.jp.7211895 | Medline

[44.]

E.F. Bell, M.J. Acarregui.

Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants.

Cochrane Database Syst Rev, 1 (2008),

http://dx.doi.org/10.1002/14651858.CD009601 | Medline

[45.]

A. Gonzalez, I.R. Sosenko, J. Chandar, H. Hummler, N. Claure, E. Bancalari.

Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighing 1000 grams or less.

J Pediatr, 128 (1996), pp. 470-478

Medline

[46.]

M. Liljedahl, L. Bodin, J. Schollin.

Coagulase-negative staphylococcal sepsis as a predictor of bronchopulmonary dysplasia.

Acta Paediatr, 93 (2004), pp. 211-215

Medline

[47.]

D. Bassler, B.J. Stoll, B. Schmidt, E.V. Asztalos, R.S. Roberts, C.M. Robertson, R.S. Sauve.

Using a count of neonatal morbidities to predict poor outcome in extremely low birth weight infants: added role of neonatal infection. Trial of Indomethacin Prophylaxis in Preterms Investigators.

Pediatrics, 123 (2009), pp. 313-318

http://dx.doi.org/10.1542/peds.2008-0377 | Medline

[48.]

M. Moro, J. Pérez-Rodriguez, J. Figueras-Aloy, C. Fernández, E. Doménech, R. Jiménez, V. Pérez-Sheriff, J. Quero, V. Roques.

Predischarge morbidities in extremely and very low-birth-weight infants in spanish neonatal units.

Am J Perinatol, 17 (2008),

[49.]

P. Lundqvist, K. Källén, I. Hallström, L.H. Westas.

Trends in outcomes for very preterm infants in the southern region of Sweden over a 10-year period.

Acta Paediatr, 98 (2009), pp. 648-653

http://dx.doi.org/10.1111/j.1651-2227.2008.01155.x | Medline

[50.]

S.G. Golombek, A. Sola, H. Baquero, D. Borbonet, F. Cabañas, C. Fajardo, G. Goldsmit, L. Lemus, E. Miura, A. Pellicer, J.M. Pérez, M. Rogido, G. Zambosco, B. van Overmeire, Primer Grupo de Consenso Clínico SIBEN, S.G. Golombek, A. Sola, R. Clyman, B. van Overmeire, G. Goldsmit, D. Natta, G. Zambosco, E. Miura, J.M. Péerez, C. Weissheimer, H. Baquero, J. García Harker, A.N. Oviedo Barrantes, M. Morgues, J.L. Tapia, F. Domínguez, M. Majano, F. Cabañas, A. Pellicer, H. Cruz, C. Fajardo, M. Rogido, L. Lemus, A.V. Origel, J.M. Lacarruba, M. Lee, J. Tresierra, H. Guimarães, R. Bustos, D. Borbonet, J.L. Perales.

An Pediatr, 69 (2008), pp. 454-481

[51.]

A. Ohlsson, R. Walia, S. Shah.

Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants.

Cochrane Database Syst Rev, 23 (2008), pp. CD003481

[52.]

R. Mosalli, K. Alfaleh.

Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants.

Cochrane Database Syst Rev, 23 (2008), pp. CD006181

[53.]

D. McCurnin, S. Seidner, L.Y. Chang, N. Waleh, M. Ikegami, J. Petershack, B. Yoder, L. Giavedoni, K.H. Albertine, M.J. Dahl, Z.M. Wang, R.I. Clyman.

Ibuprofen-induced patent ductus arteriosus closure: physiologic, histologic, and biochemical effects on the premature lung.

Pediatrics, 121 (2008), pp. 945-956

http://dx.doi.org/10.1542/peds.2007-2051 | Medline

[54.]

W. Tin, T.E. Wiswell.

Adjunctive therapies in chronic lung disease: examining the evidence.

Semin Fetal Neonatal Med, 13 (2008), pp. 44-52

http://dx.doi.org/10.1016/j.siny.2007.09.008 | Medline

[55.]

N.R. Payne, M. LaCorte, P. Karna, S. Chen, M. Finkelstein, J.P. Goldsmith, J.H. Carpenter.

Breathsavers Group. Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative. Reduction of bronchopulmonary dysplasia after participation in the Breathsavers Group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative.

Pediatrics, 118 (2006), pp. S73-S77

http://dx.doi.org/10.1542/peds.2006-0913C | Medline

[56.]

N.R. Payne, M. LaCorte, S. Sun, P. Karna, M. LewisHunstiger, J.P. Goldsmith.

Breathsavers Group. Evaluation and development of potentially better practices to reduce bronchopulmonary dysplasia in very low birth weight infants.

Pediatrics, 118 (2006), pp. S65-S72

http://dx.doi.org/10.1542/peds.2006-0913B | Medline

[57.]

P.J. Sharek, R. Baker, F. Litman, J. Kaempf, K. Burch, E. Schwarz, S. Sun, N.R. Payne.

Evaluation and development of potentially better practices to prevent chronic lung disease and reduce lung injury in neonates.

Pediatrics, 111 (2003), pp. e426-e431

Medline