Abstract
Immature control of breathing is associated with apnea, periodic breathing, intermittent hypoxemia (IH), and bradycardia in extremely preterm infants. However, it is not clear if such events independently predict worse respiratory outcome.
To determine if analysis of cardiorespiratory monitoring data can predict unfavorable respiratory outcomes at 40 weeks(w) postmenstrual age (PMA), and other outcomes such as bronchopulmonary dysplasia (BPD) at 36w PMA.
The Prematurity-Related Ventilatory Control (Pre-Vent) study was an observational multicenter prospective cohort study including infants born <29w gestation with continuous cardiorespiratory monitoring. The primary outcome was either "favorable" (alive and previously discharged, or inpatient and off respiratory medications/O2/support at 40w PMA) or "unfavorable" (either deceased or inpatient/previously discharged on respiratory medications/O2/support at 40w PMA). 717 infants were evaluated (median birth weight 850g; gestation 26.4w), of whom 53.7% had favorable and 46.3% had unfavorable outcome. Physiologic data predicted unfavorable outcome, with accuracy improving with advancing age (AUC 0.79 at Day 7, 0.85 at Day 28 and 32w PMA). The physiologic variable that contributed most to prediction was intermittent hypoxemia with SpO2<90% (IH90). Models with clinical data alone or combining physiologic and clinical data also had good accuracy, with AUC 0.84-0.85 at Day 7 and 14, and 0.86-0.88 at Day 28 and 32w PMA. Intermittent hypoxemia with SpO2<80% (IH80) was the major physiologic predictor of severe BPD and death or mechanical ventilation at 40w PMA.
Physiologic data are independently associated with unfavorable respiratory outcome in extremely preterm infants. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
