Determinants of chronic lung disease severity in the first year of life; A population based study.
OBJECTIVES
First, create a clinical severity score for patients with chronic lung disease of infancy (CLDi) following neonatal intensive care unit (NICU) stay. Second, using California wide population-based data, identify factors associated with clinical severity of CLDi at 4-9 months corrected gestational age (CGA).


STUDY DESIGN
Pediatric pulmonologists ranked and weighted eight factors reflecting clinical severity of CLDi. Utilizing these data we scored and assigned these to 4-9 month old CGA moderate/severe bronchopulmonary dysplasia (BPD) infants, born<30 weeks gestational age (GA), within the California High Risk Infant Follow up (HRIF) program. Infants were studied relative to factors from the California Perinatal Quality Care Collaborative (CPQCC).


RESULTS
We received survey responses from 43/88 pediatric pulmonologists from 28/53 North American training centers who are experts in CLDi. Strong agreement between ranking (72-100%) of respiratory system parameters and weighting (out of 100 points weighting was within 20 points) was observed with severity of CLDi. Data from 940 CLDi premature infants <30 weeks GA were obtained. Infants with severe CLDi scores at 4-9 months CGA (relative to a zero score) showed positive associations with being male, odds ratio[OR] = 2.45[confidence interval (CI) 1.26-4.77]), >30 ventilator days, OR = 3.82 (1.30-11.2), postnatal steroids OR = 3.94 (1.94-7.84), and a surprising inverse association with retinopathy of prematurity stage 3-4, OR = 0.24 (0.09-0.67) CONCLUSIONS: The CLDi clinical severity score allowed for standardized assessment of pulmonary morbidity, and evaluation of risk factors in the NICU for CLDi following NICU discharge. These observations point to risk factors associated with CLDi outcomes at 4-9 months CGA.
['Gage|Susan|S|', 'Kan|Peiyi|P|', 'Oehlert|John|J|', 'Gould|Jeffrey B|JB|', 'Stevenson|David K|DK|', 'Shaw|Gary M|GM|', "O'Brodovich|Hugh M|HM|"]
D001997:Bronchopulmonary Dysplasia D002908:Chronic Disease D005260:Female D005938:Glucocorticoids D006801:Humans D007223:Infant D007231:Infant, Newborn D007234:Infant, Premature D019102:Infant, Very Low Birth Weight D007363:Intensive Care Units, Neonatal D008171:Lung Diseases D008297:Male D009656:North America D012121:Respiration, Artificial D012178:Retinopathy of Prematurity D012720:Severity of Illness Index D012737:Sex Factors
chronic lung disease of infancy bronchopulmonary dysplasia premature