J Korean Med Sci.  2016 Mar;31(3):423-429. 10.3346/jkms.2016.31.3.423.

Trends in Survival and Incidence of Bronchopulmonary Dysplasia in Extremely Preterm Infants at 23-26 Weeks Gestation

• Kim JK
• Chang YS
• Sung S
• Ahn SY
• Yoo HS
• Park WS

• KMID: 2363504
• DOI: http://doi.org/10.3346/jkms.2016.31.3.423

Abstract

The aim of this study was to investigate the relationship between survival and incidence of bronchopulmonary dysplasia (BPD) in extremely premature infants, and identify clinical factors responsible for this association. Medical records of 350 infants at 23-26 weeks gestation from 2000 to 2005 (period I, n = 137) and 2006 to 2010 (period II, n = 213) were retrospectively reviewed. The infants were stratified into 23-24 and 25-26 weeks gestation, and the survival, BPD incidence, and clinical characteristics were analyzed. BPD was defined as oxygen dependency at 36 weeks postmenstrual age. The overall survival rate was significantly improved in period II compared to period I (80.3% vs. 70.0%, respectively; P = 0.028), especially in infants at 23-24 weeks gestation (73.9% vs. 47.4%, respectively; P = 0.001). The BPD incidence in survivors during period II (55.0%) was significantly decreased compared to period I (67.7%; P = 0.042), especially at 25-26 weeks gestation (41.7% vs. 62.3%, respectively; P = 0.008). Significantly improved survival at 23-24 weeks gestation was associated with a higher antenatal steroid use and an improved 5-minute Apgar score. A significant decrease in BPD incidence at 25-26 weeks gestation was associated with early extubation, prolonged use of less invasive continuous positive airway pressure, and reduced supplemental oxygen. Improved perinatal and neonatal care can simultaneously lead to improved survival and decreased BPD incidence in extremely premature infants.

Keyword

Bronchopulmonary Dysplasia; Continuous Positive Airway Pressure; Extremely Premature Infants; Survival Rate

MeSH Terms

Adult
Bronchopulmonary Dysplasia/epidemiology/*mortality
Demography
Female
Gestational Age
Humans
Incidence
Infant, Extremely Premature
Infant, Newborn
Intensive Care Units, Neonatal
Male
Multivariate Analysis
Odds Ratio
Pregnancy
Retrospective Studies
Severity of Illness Index
Survival Rate/*trends

Figure

• 

  Fig. 1 Survival rate and incidence of bronchopulmonary dysplasia in extremely preterm infant survivors according to time period. The overall survival rate was improved in period II compared to that in period I, especially in infants at 23–24 weeks gestation. The BPD incidence in survivors was decreased during period II compared to that in period I, especially in infants at 25–26 weeks gestation. Improved perinatal and neonatal care can simultaneously lead to improved survival and decreased incidence of bronchopulmonary dysplasia. *P < 0.05.

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