Hypoxemia and Risk for Bronchopulmonary Dysplasia In Preterm Infants

Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants associated with extreme prematurity.  Understanding contributing factors is important since there is a strong link between this condition and neurodevelopmental impairment and other childhood disease.  This study demonstrated a strong association between frequency and severity of oxygen desaturations in the development of severe BPD.  Importantly, oxygen desaturations of 1 minute or longer were significantly correlated.  

Abstract

Rationale: Bronchopulmonary dysplasia increases the risk of disability in extremely preterm infants. Although the pathophysiology remains uncertain, prior exposure to intermittent hypoxemia may play a role in this relationship. Objectives: To determine the association between prolonged episodes of intermittent hypoxemia and severe bronchopulmonary dysplasia. Methods: A post hoc analysis of extremely preterm infants in the Canadian Oxygen Trial who survived to 36 weeks' postmenstrual age was performed. Oxygen saturations <80% for ⩾1 minute and the proportion of time per day with hypoxemia were quantified using continuous pulse oximetry data that had been sampled every 10 seconds from within 24 hours of birth until 36 weeks' postmenstrual age. The study outcome was severe bronchopulmonary dysplasia as defined in the 2001 NIH Workshop Summary. Measurements and Main Results: Of 1,018 infants, 332 (32.6%) developed severe bronchopulmonary dysplasia. The median number of hypoxemic episodes ranged from 0.8/day (interquartile range, 0.2-1.1) to 60.2/day (interquartile range, 51.4-70.3) among the least and most affected 10% of infants. Compared with the lowest decile of exposure to hypoxemic episodes, the adjusted relative risk of severe bronchopulmonary dysplasia increased progressively from 1.72 (95% confidence interval, 1.55-1.90) at the 2nd decile to 20.40 (95% confidence interval, 12.88-32.32) at the 10th decile. Similar risk gradients were observed for time in hypoxemia. Significant differences in the rates of hypoxemia between infants with and without severe bronchopulmonary dysplasia emerged within the first week after birth. Conclusions: Prolonged intermittent hypoxemia beginning in the first week after birth was associated with an increased risk of developing severe bronchopulmonary dysplasia among extremely preterm infants. Clinical trial registered with www.isrctn.com (ISRCTN62491227) and www.clinicaltrials.gov 

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Setting Discharge Goals for High Risk Infants

 A useful and much study needed since neonatologists and consulting pediatric pulmonologists rely on few reliable indicators to judge discharge readiness.  And with little guidance, often managed care restrictions may prompt premature discharge.  A baseline CO2 retention above a certain threshold always seemed like at least 1 useful measure, now supported by this South Korean study.

Children with chronic lung disease of prematurity tend to have reduced lung function, increased susceptibility to respiratory viral illness, and elevated risk for rehospitalization.  Setting goals for discharge are greatly needed in this high risk population.

Capillary partial pressure of carbon dioxide for predicting rehospitalization in preterm infants under noninvasive respiratory support with severe bronchopulmonary dysplasia

Abstract

Background

The severity of bronchopulmonary dysplasia (BPD) is an important predictor of prognosis in preterm infants. However, the severity of BPD was determined mainly by the degree of oxygen supplementation and mode of respiratory support.

Objectives

This retrospective study aimed to examine the role of partial pressure of carbon dioxide (pCO2) in predicting rehospitalization among preterm infants with severe BPD without invasive ventilation at 36 weeks' postmenstrual age (PMA).

Methods

We assessed preterm infants aged <32 gestational weeks with severe BPD who were receiving noninvasive respiratory support at 36 weeks' PMA. Patients were compared after stratifying them according to the history of rehospitalization owing to respiratory infection before a corrected age (CA) of 1 year and pCO2 measured by capillary blood gas analysis at 36 weeks' PMA.

Results

Among 54 infants who had severe BPD with noninvasive respiratory support at 36 weeks' PMA, 16 (29.6%) experienced rehospitalization due to respiratory problems. At 36 weeks' PMA, the amount of oxygen supplementation (0.30 vs. 0.28, p = 0.021) and pCO2 (62.1 vs. 53.6 mmHg, p = 0.006) were higher in the rehospitalization group than in the no rehospitalization group. Multivariate logistic analysis findings indicated that pCO2 ≥ 57.4 mmHg was the only factor associated with rehospitalization (adjusted odds ratio: 8.017, 95% confidence interval 1.239–51.859).

Conclusion

High pCO2 during noninvasive respiratory support at 36 weeks' PMA in severe BPD was associated with rehospitalization. Consideration of the degree of impairment in ventilatory capacity may improve the prediction of later respiratory outcomes in infants with BPD.

Pediatric Pulmonology

Volume56, Issue12

December 2021

Pages 3863-3869

Read abstract here.

Antibiotics in Childhood Asthma

Most experts agree that there is little role in use of antibiotics in chronic or acute treatment of asthma.  In addition, antibiotic overuse may delay diagnosis and management of a chronic condition and undermine medical provider recommendations. 

After all, if an inflammatory lung condition is repeatedly conflated with an infectious process, families may lose faith in medical care and seek treatment options elsewhere.

Dr. Susarla

Children with asthma are prescribed antibiotics at a higher rate than those without asthma, according to a study published in BMJ Open. Furthermore, the diseases for which they are prescribed typically do not call for antibiotics.

This underscores the importance of measured distribution of antibiotics among physicians to avoid overprescribing and its consequences, which include further infection and microbial resistance.

This population-based retrospective cohort study included data from 26,750 participants with asthma and 330,916 without asthma, all of whom were aged 5 to 18 years old. Asthma was defined by ≥2 respiratory drug prescriptions within 1 year after receiving an asthma code. Data were collected from The Health Improvement Network (THIN) in the UK and Integrated Primary Care Information Database (IPCI) in the Netherlands. Rates of antibiotic prescriptions were compared using a Poisson regression model, and use indications were compared between individuals with and without asthma using Fisher's exact or chi-square tests.

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World Lung Day

Awareness about chronic lung conditions can help foster education and prevention strategies for both adult and pediatric disease. Dr. Susarla.

Statement of Harold P. Wimmer, National President and CEO of the American Lung Association, in response on World Lung Day, September 25, 2018, and in response to the pending vote on the declaration on the prevention and control of non-communicable diseases by the United Nations General Assembly:

“Today marks World Lung Day, a day that recognizes a fundamental truth: that breathing is essential to life. Unfortunately, millions of people around the world, including more than 33.6 million Americans, suffer from chronic lung diseases, making the essential act of breathing much more difficult.  The American Lung Association joins with others who have signed the Charter for Lung Health and pledge to continue to work to save lives by improving lung health and preventing lung disease.

“Today, we urge the United Nations to join us in this pledge. We urge the U.N. General Assembly at their meeting this week to adopt a declaration in support of efforts to reduce the burden of non-communicable lung diseases, such as asthma, chronic obstructive pulmonary disease (COPD), and lung cancer. We urge them to fully support measures to tackle the sources that cause or worsen these diseases, especially tobacco use, indoor and outdoor air pollution, and climate change. Too many people die each year from preventable diseases that these sources cause or exacerbate.  

“We have made progress in our fight against lung diseases, but millions of people face threats to their lung health every day, making it more difficult to breathe. We at the American Lung Association urge the United Nations to join in the fight to protect their health.”

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