Antenatal Determinants of Bronchopulmonary Dysplasia and Late Respiratory Disease in Preterm Infants
Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood. To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, long...
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| Published in: | American journal of respiratory and critical care medicine Vol. 196; no. 3; pp. 364 - 374 |
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| Main Authors: | , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
American Thoracic Society
01.08.2017
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| ISSN: | 1073-449X, 1535-4970 |
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| Abstract | Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood.
To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, longitudinal study of 587 preterm infants with gestational age less than 34 weeks and birth weights between 500 and 1,250 g.
Data collected included perinatal information and assessments during the neonatal intensive care unit admission and longitudinal follow-up by questionnaire until 2 years of age.
After adjusting for covariates, we found that maternal smoking prior to preterm birth increased the odds of having an infant with BPD by twofold (P = 0.02). Maternal smoking was associated with prolonged mechanical ventilation and respiratory support during the neonatal intensive care unit admission. Preexisting hypertension was associated with a twofold (P = 0.04) increase in odds for BPD. Lower gestational age and birth weight z-scores were associated with BPD. Preterm infants who were exposed to maternal smoking had higher rates of late respiratory disease during childhood. Twenty-two percent of infants diagnosed with BPD and 34% of preterm infants without BPD had no clinical signs of late respiratory disease during early childhood.
We conclude that maternal smoking and hypertension increase the odds for developing BPD after preterm birth, and that maternal smoking is strongly associated with increased odds for late respiratory morbidities during early childhood. These findings suggest that in addition to the BPD diagnosis at 36 weeks, other factors modulate late respiratory outcomes during childhood. We speculate that measures to reduce maternal smoking not only will lower the risk for preterm birth but also will improve late respiratory morbidities after preterm birth. |
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| AbstractList | RATIONALEMechanisms contributing to chronic lung disease after preterm birth are incompletely understood.OBJECTIVESTo identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, longitudinal study of 587 preterm infants with gestational age less than 34 weeks and birth weights between 500 and 1,250 g.METHODSData collected included perinatal information and assessments during the neonatal intensive care unit admission and longitudinal follow-up by questionnaire until 2 years of age.MEASUREMENTS AND MAIN RESULTSAfter adjusting for covariates, we found that maternal smoking prior to preterm birth increased the odds of having an infant with BPD by twofold (P = 0.02). Maternal smoking was associated with prolonged mechanical ventilation and respiratory support during the neonatal intensive care unit admission. Preexisting hypertension was associated with a twofold (P = 0.04) increase in odds for BPD. Lower gestational age and birth weight z-scores were associated with BPD. Preterm infants who were exposed to maternal smoking had higher rates of late respiratory disease during childhood. Twenty-two percent of infants diagnosed with BPD and 34% of preterm infants without BPD had no clinical signs of late respiratory disease during early childhood.CONCLUSIONSWe conclude that maternal smoking and hypertension increase the odds for developing BPD after preterm birth, and that maternal smoking is strongly associated with increased odds for late respiratory morbidities during early childhood. These findings suggest that in addition to the BPD diagnosis at 36 weeks, other factors modulate late respiratory outcomes during childhood. We speculate that measures to reduce maternal smoking not only will lower the risk for preterm birth but also will improve late respiratory morbidities after preterm birth. Objectives: To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, longitudinal study of 587 preterm infants with gestational age less than 34 weeks and birth weights between 500 and 1,250 g. Methods: Data collected included perinatal information and assessments during the neonatal intensive care unit admission and longitudinal follow-up by questionnaire until 2 years of age. Because an increasing number of studies have shown that preterm birth alone is associated with late respiratory disease in childhood, links between the diagnosis of BPD at 36 weeks corrected age and persistent chronic lung disease during infancy and beyond remain unclear. [...]children with late respiratory disease were more frequently exposed to passive smoking in the household than those without late respiratory disease (Table 9). [...]we found that maternal smoking and hypertension increased the risk for developing BPD after preterm birth and that maternal smoking is strongly associated with increased risk for late respiratory morbidities during early childhood. Rationale: Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood. Objectives: To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, longitudinal study of 587 preterm infants with gestational age less than 34 weeks and birth weights between 500 and 1,250 g. Methods: Data collected included perinatal information and assessments during the neonatal intensive care unit admission and longitudinal follow-up by questionnaire until 2 years of age. Measurements and Main Results: After adjusting for covariates, we found that maternal smoking prior to preterm birth increased the odds of having an infant with BPD by twofold (P = 0.02). Maternal smoking was associated with prolonged mechanical ventilation and respiratory support during the neonatal intensive care unit admission. Preexisting hypertension was associated with a twofold (P = 0.04) increase in odds for BPD. Lower gestational age and birth weight z-scores were associated with BPD. Preterm infants who were exposed to maternal smoking had higher rates of late respiratory disease during childhood. Twenty-two percent of infants diagnosed with BPD and 34% of preterm infants without BPD had no clinical signs of late respiratory disease during early childhood. Conclusions: We conclude that maternal smoking and hypertension increase the odds for developing BPD after preterm birth, and that maternal smoking is strongly associated with increased odds for late respiratory morbidities during early childhood. These findings suggest that in addition to the BPD diagnosis at 36 weeks, other factors modulate late respiratory outcomes during childhood. We speculate that measures to reduce maternal smoking not only will lower the risk for preterm birth but also will improve late respiratory morbidities after preterm birth. Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood. To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, longitudinal study of 587 preterm infants with gestational age less than 34 weeks and birth weights between 500 and 1,250 g. Data collected included perinatal information and assessments during the neonatal intensive care unit admission and longitudinal follow-up by questionnaire until 2 years of age. After adjusting for covariates, we found that maternal smoking prior to preterm birth increased the odds of having an infant with BPD by twofold (P = 0.02). Maternal smoking was associated with prolonged mechanical ventilation and respiratory support during the neonatal intensive care unit admission. Preexisting hypertension was associated with a twofold (P = 0.04) increase in odds for BPD. Lower gestational age and birth weight z-scores were associated with BPD. Preterm infants who were exposed to maternal smoking had higher rates of late respiratory disease during childhood. Twenty-two percent of infants diagnosed with BPD and 34% of preterm infants without BPD had no clinical signs of late respiratory disease during early childhood. We conclude that maternal smoking and hypertension increase the odds for developing BPD after preterm birth, and that maternal smoking is strongly associated with increased odds for late respiratory morbidities during early childhood. These findings suggest that in addition to the BPD diagnosis at 36 weeks, other factors modulate late respiratory outcomes during childhood. We speculate that measures to reduce maternal smoking not only will lower the risk for preterm birth but also will improve late respiratory morbidities after preterm birth. |
| Author | Morrow, Lindsey A. Poindexter, Brenda B. Ingram, David A. Sontag, Marci K. Mourani, Peter M. Abman, Steven H. Schibler, Kurt Dagle, John Wagner, Brandie D. Cotten, C. Michael |
| Author_xml | – sequence: 1 givenname: Lindsey A. surname: Morrow fullname: Morrow, Lindsey A. organization: Pediatric Heart Lung Center, Department of Pediatrics, Children’s Hospital Colorado, Department of Biostatistics and Informatics – sequence: 2 givenname: Brandie D. surname: Wagner fullname: Wagner, Brandie D. organization: Pediatric Heart Lung Center, Department of Pediatrics, Children’s Hospital Colorado, Department of Biostatistics and Informatics – sequence: 3 givenname: David A. surname: Ingram fullname: Ingram, David A. organization: Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana – sequence: 4 givenname: Brenda B. surname: Poindexter fullname: Poindexter, Brenda B. organization: Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio – sequence: 5 givenname: Kurt surname: Schibler fullname: Schibler, Kurt organization: Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio – sequence: 6 givenname: C. Michael surname: Cotten fullname: Cotten, C. Michael organization: Department of Neonatology, Duke University Medical School, Durham, North Carolina; and – sequence: 7 givenname: John surname: Dagle fullname: Dagle, John organization: Division of Neonatology, Carver College of Medicine, University of Iowa, Iowa City, Iowa – sequence: 8 givenname: Marci K. surname: Sontag fullname: Sontag, Marci K. organization: Department of Epidemiology – sequence: 9 givenname: Peter M. surname: Mourani fullname: Mourani, Peter M. organization: Pediatric Heart Lung Center, Department of Pediatrics, Children’s Hospital Colorado, Section of Critical Care, and – sequence: 10 givenname: Steven H. surname: Abman fullname: Abman, Steven H. organization: Pediatric Heart Lung Center, Department of Pediatrics, Children’s Hospital Colorado, Section of Pulmonary Medicine, School of Public Health, University of Colorado Denver Anschutz Medical Center, Aurora, Colorado |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28249118$$D View this record in MEDLINE/PubMed |
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| Snippet | Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood.
To identify antenatal risk factors associated with increased... Objectives: To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early... RATIONALEMechanisms contributing to chronic lung disease after preterm birth are incompletely understood.OBJECTIVESTo identify antenatal risk factors... Rationale: Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood. Objectives: To identify antenatal risk factors... |
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| SubjectTerms | Age Asthma Babies Bronchopulmonary Dysplasia - epidemiology Causality Colorado - epidemiology Female Follow-Up Studies Health risk assessment Humans Hyperoxia Hypertension - epidemiology Infant, Newborn Infant, Premature Intensive care Longitudinal Studies Lung diseases Male Morbidity Mothers - statistics & numerical data Newborn babies Original Pediatrics Preeclampsia Pregnancy Premature babies Premature birth Prenatal Exposure Delayed Effects - epidemiology Prospective Studies Pulmonary arteries Pulmonary hypertension Respiratory diseases Respiratory Distress Syndrome, Newborn - epidemiology Risk Factors Rodents Smoking Smoking - epidemiology Surveys and Questionnaires Ventilators |
| Title | Antenatal Determinants of Bronchopulmonary Dysplasia and Late Respiratory Disease in Preterm Infants |
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