Risk Factors for Severe Respiratory Morbidity at 2 Years of Life in Children Born Extremely Preterm With Bronchopulmonary Dysplasia.

Background: Bronchopulmonary dysplasia (BPD), defined as need for oxygen/respiratory support at 36 weeks gestational age (GA) is associated with increased risk of post-prematurity respiratory disease (PRD). We hypothesize that BPD, higher pCO2, and pulmonary hypertension (PH) before NICU discharge will predict PRD.

Objectives: (1) Identify clinical factors before NICU discharge associated with PRD by 2 years of age; (2) Identify clinical factors associated with emergency room (ER) visits by 2 years of age; (3) Compare predictive performance for PRD of individual and multivariable clinical factors.

Methodology: Children born < 29 weeks GA with ≥ 1 echocardiogram before NICU discharge at two tertiary centers were included. Retrospective chart review included clinical factors at NICU discharge, ER visits, and respiratory-related hospitalizations by 2 years. Analysis of predictors included logistic regression and ROC.

Results: We included 125 premature infants, of whom 53 (42%) had BPD, and 24 (19%) experienced PRD. All who experienced PRD had BPD. More severe BPD (OR: 96.1, CI: 12.4, 12, 383), but not hypercapnia or PH, were associated with PRD. On ROC analysis, combination of BPD severity, pCO2 and PH demonstrated 70% chance of PRD (AUC: 0.68 (95% CI: 0.55, 0.81). Presence of ≥ 2 factors had sensitivity of 50% and specificity of 97% for prediction of PRD. Children with BPD had 2.6 times as many ER visits as those without.

Conclusion: Combination of BPD severity, pCO2, and PH best predicted PRD. Identifying extremely preterm infants at high risk of developing PRD can guide counseling of families and early intervention.