A clinical scoring system to predict the development of bronchopulmonary dysplasia

Predictors of Bronchopulmonary Dysplasia in Infants With Birth Weight Less Than 1500 g

Bronchopulmonary dysplasia (BPD) is a complication of preterm and low birth weight infants. The incidence of BPD has not decreased over the past 20 years. Complications of BPD include rehospitalization, chronic lung disease, cardiovascular disease, and impaired growth and development which will affect the patient's quality of life. There are unfortunately limited data available regarding BPD in Indonesia. This study is expected to be a reference in taking preventive measures to reduce mortality and morbidity in preterm and low birth infants. This study aims to determine predictors of BPD in infants with birth weight less than 1500 g. We conducted a retrospective cohort study that included 116 infants with birth weight <1500 g. Twenty-two (19%) infants had BPD with the highest proportion (63.6%) in the 28 to 31 weeks of gestational age. Multivariate analysis showed mechanical ventilation in more than first 2 days of life (P = .008; HR = 7.7), hematocrit <39% (P = .001; HR = 12), and hemodynamically significant patent ductus arteriosus (hsPDA; P = .041; HR = 3.5) were significant predictors of BPD in infants with birth weight <1500 g.

Patent ductus arteriosus and spontaneous intestinal perforation in a cohort of preterm infants

OBJECTIVE

To assess whether either duration and magnitude of ductal shunt or medical treatment for patent ductus arteriosus (PDA) are related to spontaneous intestinal perforation (SIP).

STUDY DESIGN

Clinical charts of infants <29 weeks' gestation born from 2006 to 2018 were reviewed. Echocardiographic examinations were evaluated according to McNamara and Sehgal's staging system.

RESULTS

A higher percentage of patients with SIP had a hemodynamically significant PDA (HSPDA) and was treated with either NSAIDs or paracetamol (79% vs 53% and 81% vs 54%, respectively). Among non-treated patients, we found a 1.32 increase in the odds of SIP per day of persistence of HSPDA. In the cohort of patients treated despite the absence of HSPDA, we found a 2.35 increase in the odds of SIP per dose of drug administered.

CONCLUSION

Both treating a non-HSPDA and leaving a HSPDA to its natural history seem to be associated with SIP.

Prediction Models for Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review

OBJECTIVE

To provide an overview and critical appraisal of prediction models for bronchopulmonary dysplasia (BPD) in preterm infants.

METHODS

We searched PubMed, Embase, and the Cochrane Library to identify relevant studies (up to November 2021). We included studies that reported prediction model development and/or validation of BPD in preterm infants born at ≤32 weeks and/or ≤1,500 g birth weight. We extracted the data independently based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). We assessed risk of bias and applicability independently using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).

RESULTS

Twenty-one prediction models from 13 studies reporting on model development and 21 models from 10 studies reporting on external validation were included. Oxygen dependency at 36 weeks' postmenstrual age was the most frequently reported outcome in both development studies (71%) and validation studies (81%). The most frequently used predictors in the models were birth weight (67%), gestational age (62%), and sex (52%). Nearly all included studies had high risk of bias, most often due to inadequate analysis. Small sample sizes and insufficient event patients were common in both study types. Missing data were often not reported or were discarded. Most studies reported on the models' discrimination, while calibration was seldom assessed (development, 19%; validation, 10%). Internal validation was lacking in 69% of development studies.

CONCLUSION

The included studies had many methodological shortcomings. Future work should focus on following the recommended approaches for developing and validating BPD prediction models.

Prediction Model for Bronchopulmonary Dysplasia in Preterm Newborns

OBJECTIVE: To develop a multifactorial model that allows the prediction of bronchopulmonary dysplasia (BPD) in preterm newborns. MATERIALS AND METHODS: A single-center retrospective study of infants born below 32 + 0 weeks gestational age. We created a receiver operating characteristic curve to assess the multifactorial BPD risk and calculate the BPD risk accuracy using the area under the curve (AUC). BPD risk was categorized using a multifactorial predictive model based on the weight of the evidence. RESULTS: Of the 278 analyzed preterm newborns, 127 (46%) developed BPD. The significant risk factors for BPD in the multivariate analysis were gestational age, number of red blood cell concentrate transfusions, number of surfactant administrations, and hemodynamically significant patent ductus arteriosus. The combination of these factors determined the risk of developing BPD, with an AUC value of 0.932. A multifactorial predictive model based on these factors, weighted by their odds ratios, identified four categories of newborns with mean BPD risks of 9%, 59%, 82%, and 100%. CONCLUSION: A multifactorial model based on easily available clinical factors can predict BPD risk in preterm newborns and inform potential preventive measures.

Development and verification of a risk prediction model for bronchopulmonary dysplasia in very low birth weight infants

BACKGROUND

To analyze the risk factors of bronchopulmonary dysplasia (BPD) of very low birth weight infants (VLBWIs), and to develop and verify a risk prediction model of BPD.

METHODS

The data of 611 VLBWIs from the neonatal intensive care unit (NICU) of a tertiary grade A hospital in Suzhou from January 2017 to September 2019 were collected. The data was randomly divided into the modeling set (451 cases) and the validation set (160 cases). Binary logistic regression was used to analyze the data, and the model was examined by a receiver operating characteristic (ROC) curve. The grouped data was used to verify the sensitivity and specificity of the model.

RESULTS

The study found that neonatal asphyxia, the positive rate of sputum culture, neonatal sepsis, neonatal respiratory distress syndrome (NRDS), blood transfusions (≥3), patent ductus arteriosus (PDA), the time of invasive mechanical ventilation, the duration of oxygen therapy, and the time of parenteral nutrition were the independent risk factors of BPD, while 1 min Apgar score was a protective factor. The model formula was Z=neonatal asphyxia * 1.229 + the positive rate of sputum culture * 1.265 + neonatal sepsis * 1.677 + NRDS * 1.848 + blood transfusions (≥3) * 1.455 + PDA * 1.835 - 1 min Apgar score * 0.25 + the time of invasive mechanical ventilation * 0.123 + the duration of oxygen therapy * 0.09 + the time of parenteral nutrition * 0.057 - 8.077. The area under the ROC curve of this model was 0.965 (95% CI: 0.946-0.983), with a sensitivity of 93.7% and a specificity of 91.3%. Verification of this prediction model showed a sensitivity of 92.9% and a specificity of 76%, demonstrating that the effects of this model were satisfactory.

CONCLUSIONS

The risk prediction model had a good predictive effect for the risk of BPD in VLBWIs, and can provide a reference for preventive treatment and nursing intervention.

Association between probiotics and bronchopulmonary dysplasia in preterm infants

Bronchopulmonary dysplasia is a chronic pulmonary disease with a high incidence in premature infants, and there is still no effective treatment. The purpose of our study was to analyze the association between the use of probiotics and BPD in premature infants. We retrospectively collected clinical data of infants with gestational age < 32 weeks admitted to the NICU of The First Hospital of Jilin University from January 1, 2019 to March 31, 2020. Demographic and clinicopathological data of the inclusion population were collected. The outcome was the incidence of BPD or death. The χ² tests was used to compare the categorical variables. The t test and non-parametric Wilcoxon rank-sum test were used to compare the continuous data. Univariate and multivariate logistic regression were used to analyze the association between probiotics and BPD. A total of 318 newborns met the inclusion criteria, of which 94 received probiotics and 224 received no probiotics. There were 16 deaths and 115 newborns with BPD in the included population. The results of univariate analysis showed differences in the maternal diabetes, the proportion of systemic antibiotics given to mother within 24 h before birth, the receiving rate of invasive mechanical ventilation, the prevalence of BPD/death, PDA, RDS and Ivh between newborns with and without probiotics (p < 0.05); The results of unadjusted univariate logistic regression model showed that probiotic (OR 0.034, 95% CI 0.012-0.096) was the factor affecting BPD in preterm infants (p < 0.05). Multivariate logistic regression result (OR 0.037, 95% CI 0.013-0.105) was consistent with univariate analysis (P < 0.001). Probiotics are associated with a reduced risk of BPD in preterm infants < 32 weeks of age. More prospective studies with large samples are still needed.

Bronchopulmonary Dysplasia Predicted by Developing a Machine Learning Model of Genetic and Clinical Information

Background

An early and accurate evaluation of the risk of bronchopulmonary dysplasia (BPD) in premature infants is pivotal in implementing preventive strategies. The risk prediction models nowadays for BPD risk that included only clinical factors but without genetic factors are either too complex without practicability or provide poor-to-moderate discrimination. We aim to identify the role of genetic factors in BPD risk prediction early and accurately.

Methods

Exome sequencing was performed in a cohort of 245 premature infants (gestational age <32 weeks), with 131 BPD infants and 114 infants without BPD as controls. A gene burden test was performed to find risk genes with loss-of-function mutations or missense mutations over-represented in BPD and severe BPD (sBPD) patients, with risk gene sets (RGS) defined as BPD-RGS and sBPD-RGS, respectively. We then developed two predictive models for the risk of BPD and sBPD by integrating patient clinical and genetic features. The performance of the models was evaluated using the area under the receiver operating characteristic curve (AUROC).

Results

Thirty and 21 genes were included in BPD-RGS and sBPD-RGS, respectively. The predictive model for BPD, which combined the BPD-RGS and basic clinical risk factors, showed better discrimination than the model that was only based on basic clinical features (AUROC, 0.915 vs. AUROC, 0.814, P = 0.013, respectively) in the independent testing dataset. The same was observed in the predictive model for sBPD (AUROC, 0.907 vs. AUROC, 0.826; P = 0.016).

Conclusion

This study suggests that genetic information contributes to susceptibility to BPD. The predictive model in this study, which combined BPD-RGS with basic clinical risk factors, can thus accurately stratify BPD risk in premature infants.

[Epidemiology and risk factors for bronchopulmonary dysplasia in prematures infants born at or less than 32 weeks of gestation]

OBJECTIVES

To describe risk factors of bronchopulmonary dysplasia in very preterm infants in the first weeks of life.

MATERIAL AND METHODS

Retrospective cohort study of preterm infants ≤ 32 weeks of gestational age and birth weight ≤ 1500 g. A multivariate logistic regression analysis was performed to identify independent risk factors for bronchopulmonary dysplasia in the first weeks of life.

RESULTS

A total of 202 newborns were included in the study (mean gestational age 29.5 ± 2.1 weeks), 61.4% never received invasive mechanical ventilation. The incidence of bronchopulmonary dysplasia was 28.7%, and 10.4% of the patients were diagnosed with moderate-severe bronchopulmonary dysplasia. Bronchopulmonary dysplasia was independently associated with gestational age at birth (p < 0.001; OR = 0.44 [95% CI = 0.30-0.65]), the need for mechanical ventilation on the first day of life (p = 0.001; OR = 8.13 [95% CI = 2.41-27.42]), nosocomial sepsis (p < 0.001; OR = 9.51 [95% CI = 2.99-30.28]) and FiO2 on day 14 (p < 0.001; OR = 1.39 [95% CI = 1.16-1.66]). Receiving mechanical ventilation at the first day of life (p = 0.008; OR = 5.39 [95% CI = 1.54-18.89]) and at the third day of life (p = 0.001; OR = 9.99 [95% CI = 2.47-40.44]) and nosocomial sepsis (p = 0.001; OR = 9.87 [95% CI = 2.58-37.80]) were independent risk factors for moderate-severe bronchopulmonary dysplasia.

CONCLUSIONS

Gestational age at birth, mechanical ventilation in the first days of life and nosocomial sepsis are early risk factors for bronchopulmonary dysplasia. The analysis of simple and objective clinical data, allows us to select a group of patients at high risk of bronchopulmonary dysplasia in whom it could be justified to act more aggressively, and shows areas for improvement to prevent its development or reduce its severity.

Bronchopulmonary dysplasia predicted at birth by artificial intelligence

Aim

To develop a fast bedside test for prediction and early targeted intervention of bronchopulmonary dysplasia (BPD) to improve the outcome.

Methods

In a multicentre study of preterm infants with gestational age 24‐31 weeks, clinical data present at birth were combined with spectral data of gastric aspirate samples taken at birth and analysed using artificial intelligence. The study was designed to develop an algorithm to predict development of BPD. The BPD definition used was the consensus definition of the US National Institutes of Health: Requirement of supplemental oxygen for at least 28 days with subsequent assessment at 36 weeks postmenstrual age.

Results

Twenty‐six (43%) of the 61 included infants developed BPD. Spectral data analysis of the gastric aspirates identified the most important wave numbers for classification and surfactant treatment, and birth weight and gestational age were the most important predictive clinical data. By combining these data, the resulting algorithm for early diagnosis of BPD had a sensitivity of 88% and a specificity of 91%.

Conclusion

A point‐of‐care test to predict subsequent development of BPD at birth has been developed using a new software algorithm allowing early targeted intervention of BPD which could improve the outcome.

Molecular and Mechanical Mechanisms Regulating Ductus Arteriosus Closure in Preterm Infants

Failure of ductus arteriosus closure after preterm birth is associated with significant morbidities. Ductal closure requires and is regulated by a complex interplay of molecular and mechanical mechanisms with underlying genetic factors. In utero patency of the ductus is maintained by low oxygen tension, high levels of prostaglandins, nitric oxide and carbon monoxide. After birth, ductal closure occurs first by functional closure, followed by anatomical remodeling. High oxygen tension and decreased prostaglandin levels mediated by numerous factors including potassium channels, endothelin-1, isoprostanes lead to the contraction of the ductus. Bradykinin and corticosteroids also induce ductal constriction by attenuating the sensitivity of the ductus to PGE2. Smooth muscle cells of the ductus can sense oxygen through a mitochondrial network by the role of Rho-kinase pathway which ends up with increased intracellular calcium levels and contraction of myosin light chains. Anatomical closure of the ductus is also complex with various mechanisms such as migration and proliferation of smooth muscle cells, extracellular matrix production, endothelial cell proliferation which mediate cushion formation with the interaction of blood cells. Regulation of vessel walls is affected by retinoic acid, TGF-β1, notch signaling, hyaluronan, fibronectin, chondroitin sulfate, elastin, and vascular endothelial cell growth factor (VEGF). Formation of the platelet plug facilitates luminal remodeling by the obstruction of the constricted ductal lumen. Vasa vasorum are more pronounced in the term ductus but are less active in the preterm ductus. More than 100 genes are effective in the prostaglandin pathway or in vascular smooth muscle development and structure may affect the patency of ductus. Hemodynamic changes after birth including fluid load and flow characteristics as well as shear forces within the ductus also stimulate closure. Current pharmacological treatment for the closure of a patent ductus is based on the blockage of the prostaglandin pathway mainly through COX or POX inhibition, albeit with some limitations and side effects. Further research for new agents aiming ductal closure should focus on a clear understanding of vascular biology of the ductus.

Exploring clinical, echocardiographic and molecular biomarkers to predict bronchopulmonary dysplasia

Introduction

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in childhood, related to prematurity, and the most common cause of pulmonary hypertension (PH) secondary to pulmonary disease in children. Moderate and severe BPD have a worse outcome and relate more frequently with PH. The prediction of moderate or severe BPD development in extremely premature newborns is vital to implement preventive strategies. Starting with the hypothesis that molecular biomarkers were better than clinical and echocardiographic factors, this study aims to explore the ability of clinical, echocardiographic and analytical variables to predict moderate or severe BPD in a cohort of extremely preterm infants.

Patients and methods

We designed a prospective longitudinal study, in which we followed a cohort of preterm newborns (gestational age <28 weeks and weight ≤ 1250 grams). In these newborns we recorded weekly clinical and echocardiographic variables as well as blood and tracheal aspirate samples, to analyze molecular biomarkers (IL-6, IL-1, IP10, uric acid, HGF, endothelin-1, VEGF, CCL5). Variables and samples were collected since birth up to week 36 (postmenstrual age), time-point at which the diagnosis of BPD is established.

Results

We included 50 patients with a median gestational age of 26 weeks (IQR 25–27) and weight of 871 g (SD 161,0) (range 590-1200g). Three patients were excluded due to an early death. Thirty-five patients (74.5%) developed BPD (mild n = 14, moderate n = 15, severe n = 6). We performed a logistic regression in order to identify risk factors for moderate or severe BPD. We compared two predictive models, one with two variables (mechanical ventilation and inter-ventricular septum flattening), and another-one with an additional molecular biomarker (ET-1).

Conclusions

The combination of clinical and echocardiographic variables is a valuable tool for determining the risk of BPD. We find the two variable model (mechanical ventilation and echocardiographic signs of PH) more practical for clinical and research purposes. Future research on BPD prediction should be oriented to explore the potential role of ET-1.

A clinical scoring system to predict the development of intraventricular hemorrhage (IVH) in premature infants

OBJECTıVE: The aim of this study is to develop a scoring system for the prediction of intraventricular hemorrhage (IVH) in preterm infants in the first 7 days of life.

METHODS

A prospective, clinical study was conducted in Bahcesehir University, Medical Park Goztepe Hospital Neonatal Intensive Care Unit, with the enrollment of 144 preterm infants with gestational age between 24 and 34 weeks. All preterms were followed up for IVH after birth until the 4th week of life. The demographic characteristics and clinical risk factors were noted. Risk factors were analyzed. The score was established after logistic regression analysis, considering the impact of each variable on the occurrence of IVH within the first 7 days of life. The IVH scores were further applied prospectively to 89 preterm infants as validation cohort.

RESULTS

Low gestational age (GA), low Apgar score, and having bleeding diathesis were the most important risk factors for IVH. According to these risk factors, a scoring system was developed for IVH ranged from 0 to 5. According to the risk ratios (RR) obtained from the logistic regression model, low GA (≤ 28 gestational week), presence of bleeding diathesis within 7 days, and low Apgar score increased the risk of IVH (RR = 3.32 for GA ≤ 28 gestational week, RR = 6.7 for presence of bleeding diathesis in 7th day, RR = 3 for having low Apgar score). The score was validated successfully in 89 infants. The area under ROC curve was 0.85 for derivation cohort and 0.807 for validation cohort. The predictive ability of the IVH score for derivation and validation cohort was calculated. The negative predictive values of a score less than 4 were 96.4 and 59.1%. CONCLUSıON: Concerning IVH-related sequelae which continue to be a major public health problem, we have developed a feasible predictive model for evaluating the risk for developing IVH for preterm infants in the first 7 days of life.

The influence of gender on respiratory outcomes in children with bronchopulmonary dysplasia during the first 3 years of life

INTRODUCTION

Since premature males are more likely to be diagnosed with bronchopulmonary dysplasia we hypothesized that differences in respiratory outcomes after initial hospital discharge and during the first 3 years of life would exist between females and males diagnosed with BPD.

METHODS

Subjects with the diagnosis of BPD were recruited from the Johns Hopkins Bronchopulmonary Dysplasia Clinic between 2008 and 2014. Clinical features were assessed through chart review (n = 482). Respiratory morbidities were assessed by caregiver questionnaires at clinic visits (n = 429), including emergency department visits, hospital admissions, systemic steroid use, and antibiotic use for respiratory reasons since the last BPD clinic visit or after initial hospital discharge if assessed at the first visit.

RESULTS

Male infants weighed significantly more at birth, had higher birth weight percentiles and were more likely to be non-white compared to female infants. The frequency of ever acute care use was 36.9% for emergency department visits, 27.4% for hospital admissions, 36.9% for systemic steroid use, and 40.5% for antibiotic use for a respiratory illness. No differences in respiratory morbidities were found between males and females. Females however, tended to be weaned from supplemental oxygen over 3 months later than males.

CONCLUSIONS

Compared to females with BPD, males were more likely to weigh more, have higher birth weight percentiles and be non-white. After initial hospital discharge, there were no difference in respiratory morbidities between males and females with BPD. Female infants however were more likely to be weaned from supplemental oxygen at a later age than male infants. Pediatr Pulmonol. 2017;52:217-224. © 2016 Wiley Periodicals, Inc.

A risk factor analysis on disease severity in 47 premature infants with bronchopulmonary dysplasia

Bronchopulmonary Dysplasia (BPD) is a rare chronic lung disease and one of the most difficult complications to treat in premature infants. With the progress at the medical treatment level, an increasing number of BPD premature infants are born, meanwhile, they would be at an increasing risk for numerous complications and rehospitalization because BPD affects many vital organ systems. The pathogenesis of BPD is clearly multifactorial. As the prognosis is closely connected with the severity of BPD, early diagnosis and treatment are of great help to control the development of BPD. This article focuses on risk factors that could influence the severity of BPD in order to provide a reliable basis for early diagnosis, treatment, and better patient assessment.