J Korean Med Sci.  2005 Jun;20(3):397-401. 10.3346/jkms.2005.20.3.397.

Scoring Method for Early Prediction of Neonatal Chronic Lung Disease Using Modified Respiratory Parameters

• Kim YD
• Kim EA
• Kim KS
• Pi SY
• Kang W

• KMID: 1778496
• DOI: http://doi.org/10.3346/jkms.2005.20.3.397

Abstract

In our previous study, we have demonstrated that peak inspiratory pressure over birth weight (PIP/kg) and mean airway pressure over birth weight (MAP/kg) were more significant risk factors for the development of neonatal chronic lung disease (CLD) than PIP and MAP. We aimed to develop a scoring method using the modified respiratory variables (SMUMRV) to predict CLD at early postnatal period. From 1997 to 1999, a retrospective review was performed for 197 infants <1,500 g for the development of the SMUMRV based on statistical analysis. From 2000 to 2001, calculated scores on day 4, 7 and 10 of life were obtained prospectively for 107 infants <1,500 g. Predictive values and the area under the receiver operator characteristic curve (AUC) were determined and compared with the result of the previous regression model. Gestational age, birth weight, 5 min Apgar score, PIP/kg at 12 hr of age, fractional inspired oxygen (FiO2), MAP/kg, modified oxygenation index and ventilatory mode were selected as parameters of SMUMRV. No significant differences of AUCs were found between the SMUMRV and the Yoder model. It is likely that our scoring method provides reliable values for predicting the development of CLD in very low birth weight infants.

Keyword

Bronchopulmonary Dysplasia; Infant, Premature; Predictive Value of Tests; ROC Curve; Scoring Method; Epidemiologic Research Design

MeSH Terms

Analysis of Variance
Birth Weight
Chronic Disease
Comparative Study
Female
Humans
Infant, Newborn
Lung Diseases/*diagnosis
Male
Predictive Value of Tests
Prognosis
Prospective Studies
Respiratory Function Tests/*methods
Retrospective Studies
Sensitivity and Specificity
Time Factors

Figure

• 

  Fig. 1 Comparison of ROC curves of predictive models at day 4 (A), 7 (B) and 10 (C) of life for neonatal chronic lung disease [SMUMRV (solid line) vs. Yoder model (dotted line)]. CLD is defined at 36 weeks of corrected age. Area under the curve: (A) SMUMRV, 0.90 (SEM, 0.07); Yoder, 0.92 (SEM, 0.06); p=0.73, (B) SMUMRV, 0.91 (SEM, 0.07); Yoder, 0.96 (SEM, 0.05); p=0.38, (C) SMUMRV, 0.94 (SEM, 0.05); Yoder, 0.95 (SEM, 0.05); p=0.85.

Reference

1. Avery ME, Tooley WH, Keller JB, Hurd SS, Bryan MH, Cotton RB, Epstein MF, Fitzhardinge PM, Hansen CB, Hansen TN. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics. 1987. 79:26–30.

2. Northway WH Jr, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967. 276:357–368.

3. Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics. 1988. 82:527–532.

4. Tammela OK, Koivisto ME. Fluid restriction for preventing bronchopulmonary dysplasia? Reduced fluid intake during the first weeks of life improves the outcome of low-birth-weight infants. Acta Paediatr. 1992. 81:207–212.

5. Halliday HL, Ehrenkranz RA. Early postnatal (<96 hours) corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2000. (1):CD001146.

6. Shenai JP, Kennedy KA, Chytil F, Stahlman MT. Clinical trial of vitamin A supplementation in infants susceptible to bronchopulmonary dysplasia. J Pediatr. 1987. 111:269–277.

7. Mariani G, Cifuentes J, Carlo WA. Randomized trial of permissive hypercapnia in preterm infants. Pediatrics. 1999. 104:1082–1088.

8. HiFi Study Group. High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants: assessment of pulmonary function at 9 months of corrected age. J Pediatr. 1990. 116:933–941.

9. Banks BA, Seri I, Ischiropoulos H, Merrill J, Rychik J, Ballard RA. Changes in oxygenation with inhaled nitric oxide in severe bronchopulmonary dysplasia. Pediatrics. 1999. 103:610–618.

10. Sinkin RA, Cox C, Phelps DL. Predicting risk for bronchopulmonary dysplasia: selection criteria for clinical trials. Pediatrics. 1990. 86:728–736.

11. Ryan SW, Nycyk J, Shaw BN. Prediction of chronic neonatal lung disease on day 4 of life. Eur J Pediatr. 1996. 155:668–671.

12. Yoder BA, Anwar MU, Clark RH. Early prediction of neonatal chronic lung disease: a comparison of three scoring methods. Pediatr Pulmonol. 1999. 27:388–394.

13. Palta M, Gabbert D, Fryback D, Widjaja I, Peters ME, Farrell P, Johnson J. Development and validation of an index for scoring baseline respiratory disease in the very low birth weight neonate. Severity Index Development and Validation Panels and Newborn Lung Project. Pediatrics. 1990. 86:714–721.

14. Goldman SL, Gerhardt T, Sonni R, Feller R, Hehre D, Tapia JL, Bancalari E. Early prediction of chronic lung disease by pulmonary function testing. J Pediatr. 1983. 102:613–617.

15. Bhutani VK, Abbasi S. Relative likelihood of bronchopulmonary dysplasia based on pulmonary mechanics measured in preterm neonates during the first week of life. J Pediatr. 1992. 120:605–613.

16. Corcoran JD, Patterson CC, Thomas PS, Halliday HL. Reduction in the risk of bronchopulmonary dysplasia from 1980-1990: results of a multivariate logistic regression analysis. Eur J Pediatr. 1993. 152:677–681.

17. Farstad T, Bratlid D. Incidence and prediction of bronchopulmonary dysplasia in a cohort of premature infants. Acta Paediatr. 1994. 83:19–24.

18. Ryan SW, Wild NJ, Arthur RJ, Shaw BN. Prediction of chronic neonatal lung disease in very low birthweight neonates using clinical and radiological variables. Arch Dis Child Fetal Neonatal Ed. 1994. 71:F36–F39.

19. Hentschel J, Friedel C, Maier RF, Bassir C, Obladen M. Predicting chronic lung disease in very low birthweight infants: comparison of 3 scores. J Perinat Med. 1998. 26:378–383.

20. Kim YD, Kim EA, Kim KS, Pi SY, Lee JJ, Park SJ. Perinatal risk factors for the development of bronchopulmonary dysplasia in premature infants less than 32 weeks' gestation. J Korean Soc Neonatal. 2001. 8:78–93.

21. Goldsmith JP, Karotkin EH. Goldsmith JP, editor. Introduction to assisted ventilation. Assisted ventilation of the neonate. 1996. 3rd ed. Philadelphia: WB Saunders;1–19.

22. Courtney SE, Durand DJ, Asselin JM, Hudak ML, Aschner JL, Shoemaker CT. High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants. N Engl J Med. 2002. 347:643–652.