Measuring what matters: Respiratory archetypes in extreme preterm neonates

Background: Descriptions of course of illness during prolonged intensive care is as essential as studying outcomes in extremely low gestational age neonates (ELGANs). Understanding the expected trajectory of respiratory illness aids in the recognition of risk factors followed by appropriate counselling and resource allocation. We studied the patterns of respiratory illness in ELGAN over the first 2 weeks and its association with bronchopulmonary dysplasia (BPD). Methodology: Levels of respiratory care in ELGAN from 2017 to 2021 were analysed. They were classified into four groups (pragmatically at the bedside) based on oxygen requirements as Category 1: persistent low needs (PL) – FIO2 <0.3 on day 3, and FIO2 <0.3 at 2 weeks, Category 2: progressive worsening (PW) – FIO2 <0.3 on day 3, worsening to >0.3 at 2 weeks, Category 3: persistent high needs (PH) – FIO2 >0.3 on day 3, continuing to need >0.3 at 2 weeks and Category 4: progressive improvement (PI) – FIO2 >0.3 on day 3, improving to <0.3 at 2 weeks. The proportion of infants in each group who developed BPD was also determined. Results: Seventy-four survivors of 91 live-born ELGAN were included, of whom 29.7% developed BPD. Most infants were in PL category (83.8%). Those in the worse categories (PW and PH) constituted only 4.05%. The association of classification as worse patterns (PW or PH) with BPD was not statistically significant, but the numbers were very small. Conclusions: Major proportion of ELGAN were categorised into reassuring archetypes of respiratory requirements. Drawing conclusions about the association with BPD may need analysis of a larger number of infants.