Perinatal Risk Factors for the Development of Bronchopulmonary Dysplasia in Premature Infants Less Than 32 Weeks' Gestation

Kim, Young Don; Kim, Ki Soo; Kim, Ellen Ai Rhan; Lee, Jung Joo; Park, Sung Jong; Pi, Soo Young

Abstract

OBJECTIVES
To determine the clinical characteristics and perinatal risk factors of infants with bronchopulmonary dysplasia (BPD) among premature infants less than 32 weeks' gestation and access the role of ventilatory indices and maternal factors that may predispose preterm infants to the development of chronic lung disease (CLD).
METHODS
Clinical data was collected retrospectively from the 256 premature infants less than 32 weeks' gestation and their mothers during 3-year study period.
RESULTS
Among 212 preterm infants less than 32 weeks' gestation who survived to 28 days of life, 58 (27.4%) had CLD. Predisposing neonatal factors for developing CLD included lower gestational age, lower birth weight, Apgar score at 1 and 5 minute, occlusion of PDA after day 4 of age, birth weight nadir and the duration reached to it, serum level of total white blood cell (WBC) at birth, and the level of IgM over 30 mg/dL within 7 days after birth. Maternal factors for developing CLD in their infants included maternal age, mode of delivery, use of antenatal corticosteroid, and the level of WBC count in amniotic fluid (>50/mm3). FiO2 at day 2, PIP at day 2-7 and 10, MAP at day 2, 3, 5 and 10, and oxygenation index at day 2, 3, 5-7, and 10 were significant risk factors in development of CLD. Furthermore, PIP per birth weight, MAP per birth weight, and modified oxygenation index far better predicted the development of CLD than PIP, MAP and oxygenation index per se at any ages of all infants included in the study.
CONCLUSION
In addition to neonatal factors, maternal factors including age, mode of delivery, use of antenatal corticosteroid, and the level of WBC count in amniotic fluid (>30/mm3) can be used as risk factors in predicting the development of CLD in their infants. Variable ventilatory indices (PIP, MAP, oxygenation index) in relation to birth weight could better predict the development of CLD in infants less than 32 weeks' gestation.