Antecedents of respiratory pauses in extremely low birth weightinfants supported by proportional assist ventilation

Objective. To determine characteristics of breathing patterns prior to respiratory pauses in extremely low birth weight (ELBW) infants breathing spontaneously under proportional assist ventilation (PAV).

Methods. Thirteen infants (mean ± SD: gestational age 25 ± 1 weeks; birth weight 753 ± 149 g; age 4 ± 3 days) were studied. Recordings were obtained under PAV over two-hour periods on two consecutive days. The last 10 breaths preceding respiratory pauses were analyzed.

Results. Tidal volume, inspiratory and expiratory peak flow, and mean inspiratory flow decreased in the last breaths prior to respiratory pauses compared to all other breaths (p < 0.001). Of all apneas 89% were preceded by a decrease in tidal volume of at least 33% (435/487; p < 0.001). The positive predictive value of a decrease in tidal volume to predict an apnea was 26% (435/1640; p < 0.001).

Conclusions. Decreases in tidal volume of at least 33% and in airflow are the predominant changes in the breathing pattern prior to respiratory pauses in ELBW infants, preceding 89% of all respiratory pauses. Their low positive predictive value of 26% however, indicates that further variables of breathing need to be implemented to predict cessation of breathing with higher precision.     

Early onset hyperkalemia in extremely low birth weight infants

The incidence of hyperkalemia and associated clinical features in extremely preterm infants were determined by reviewing medical records of 32 infants with birth weights of less than or equal to 800 g born during a 1-year period. Hyperkalemia, defined as serum potassium concentration of greater than 6.5 mEq/L, occurred in 12 infants on the first day of life and in four others on the second day. Six infants (38%) had electrocardiographic abnormalities associated with hyperkalemia. Infants with hyperkalemia were less mature than infants with normal potassium levels. All infants of less than 25 weeks' gestation developed hyperkalemia. Fluid intakes and urine flow rates were lower and body weight loss greater during the first 24 hours of hospitalization for hyperkalemic infants. Hyperkalemia frequently occurs within the first 48 hours of life in extremely immature infants. Serum potassium should be monitored closely to avoid life-threatening cardiac arrhythmias in these infants.     

Sudden intractable respiratory failure in extremely low birth weight infants with H-type tracheoesophageal fistula

A fatality from a tracheoesophageal fistula (TEF) in two extremely low birth weight infants is presented. The sudden onset of intractable respiratory failure accompanied by the absence of chest movement and breathing sounds was observed. The typical clinical symptoms were concealed because the infants required mechanical ventilation and nasogastric feedings. When ventilated infants with these symptoms are suspected of the diagnosis of TEF, prompt reintubation under the guidance of a flexible bronchoscopy may be life saving because the endotracheal tube passes through the fistulas into the esophagus with ease.     

147例极低和超低出生体重儿胃肠道内喂养的影响因素

目的 分析影响极低出生体重儿(very low birth weight infant,VLBWI)和超低出生体重儿(extremely low birth weight infant,ELBWI)胃肠道内喂养的相关因素.方法 对147例出院前达到足量胃肠道内喂养,即奶量达到120 ml/(kg·d)的VLBWI和ELBWI的临床资料进行回顾性研究,分析影响胃肠道内喂养的相关因素.对服从双变量正态分布的资料,采用Pearson法进行相关性分析,否则采用Spearman法进行相关性分析;应用t检验进行单因素分析;应用多元线性回归探讨达足量胃肠道内喂养时间的影响因素.结果 147例研究对象的平均胎龄(31.0±2.0)周;平均出生体重(1246±185)g;达到足量胃肠道内喂养的时间为(24.4±10.5)d.单因素分析显示出生体重(r=-0.477,P=0.000)、胎龄(r=-0.405,P=0.000)、机械通气时间(r=0.393,P=0.000)、开奶日龄(r=0.318,P=0.000)、开奶量(r=-0.263,P=0.001)、第3天奶量(r=-0.412,P=0.000)及第7天奶量(r=-0.592,P=0.000)、新生儿呼吸窘迫综合征(t=3.368,P=0.001)、血糖异常(t=3.285,P=0.001)、败血症(t=3.244,P=0.001)、脐静脉置管(t=3.571,P=0.000)、应用氨茶碱(t=4.341,P=0.000)、光疗(t=3.054,P=0.003)与达到足量喂养时间相关.多元线性回归分析显示出生体重(t=4.175,P=0.000)、开奶日龄(t=2.851,P=0.005)、应用氨茶碱(t=2.231,P=0.027)、光疗(t=2.852,P=0.005)、败血症(t=3.895,P=0.000和第7天奶量(t=7.332,P=0.000)与达到足量喂养时间相关.结论 VLBWI和ELBWI的喂养不但受消化道成熟程度影响,还受其他胃肠道外相关因素的影响,因此应综合考虑临床各方面的具体情况,正确实施胃肠道内喂养.

Abstract：

Objective To summarize and analyze the impact factors on enteral feeding in very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI). Methods A retrospective study was carried out in VLBWI and ELBWI who had achieved full enteral feeding prior to discharge. The impact factors correlated to the time of achieving full enteral feeding were analyzed. If the data underwent bi-variable normal distribution, they were analyzed with Pearson correlation test; otherwise they would be analyzed with Spearman correlation test. T test was used for single factor analysis and multiple linear regression analysis was carried out to determine the significant risk factors associated with the time of achieving full enteral feeding. Results One hundred and forty-seven infants with mean gestational age of (31.0±2.0) weeks, mean birth weight of (1246±185) g and mean time of achieving full enteral feeding of (24. 4± 10. 5) days were admitted. With the single factor analysis, it was found that birth weight (r=- 0. 477, P = 0. 000), gestational age (r = - 0. 405, P= 0. 000), mechanical ventilation duration (r= 0. 393, P = 0. 000), the time began to enteral feeding (r = 0. 318, P = 0. 000), initial milk volume (r = - 0. 263, P = 0. 001 ), the milk volume on the third day (r= -0. 412, P=0. 000) and the seventh day (r= -0. 592, P=0. 000),neonatal respiratory distress syndrome (t = 3. 368, P = 0. 001), umbilical catheterization (t = 3. 571,P=0. 000), abnormal blood glucose level (t=3. 285, P=0. 001), aminophylline using (t=4. 341,P=0. 000), phototherapy (t=3. 054, P=0. 003) and sepsis (t=3. 244, P=0. 001) were correlated to the time of achieving full enteral feeding. Multiple linear regression showed that the birth weight (t=4. 175, P= 0. 000), the time began to enteral feeding (t= 2. 851, P = 0. 005), aminophylline using (t=2. 231, P=0. 027), sepsis (t=3. 895, P=0. 000), phototherapy (t=2. 852, P=0. 005)and the milk volume on the seventh day (t= 7. 332, P=0. 000) were significantly correlated with the time of achieving full enteral feeding. Conclusions The enteral feeding of VLBWI and ELBWI was not only influenced by maturity of gastrointestinal tract, but also by other parenteral correlation factors. Multiple factors associated with all around clinical conditions should be considered when providing enteral feeding for VLBWI and ELBWI.     

Hyperglycemia and morbidity and mortality in extremely low birth weight infants.

OBJECTIVE: The purpose of this study was to determine the association between hyperglycemia and mortality and late-onset infections (>72 h) in extremely low birth weight (ELBW) infants. STUDY DESIGN: Retrospective analysis of a prospective cohort study of 201 ELBW infants who survived greater than 3 days after birth. Mean morning glucose levels were categorized as normoglycemia (<120 mg/dl), mild-moderate hyperglycemia (120 to 179 mg/dl) and severe hyperglycemia (> or =180 mg/dl). Hyperglycemia was further divided into early (first 3 days of age) and persistent (first week of age). Logistic regression was performed to assess whether hyperglycemia was associated with either mortality or late-onset culture-proven infection, measured after 3 and 7 days of age. RESULTS: Adjusting for age, the odds ratio (OR) for either dying or developing a late infection was 5.07 (95% confidence interval (CI): 1.06 to 24.3) for infants with early severe hyperglycemia and 6.26 (95% CI: 0.73 to 54.0) for infants with persistent severe hyperglycemia. Adjusting for age, both severe early and persistent hyperglycemia were associated with increased mortality. Among survivors, there was no significant association between hyperglycemia and length of mechanical ventilation or length of hospital stay. Persistent severe hyperglycemia was associated with the development of Stage II/III necrotizing enterocolitis, after adjusting for age and male gender (OR: 9.49, 95% CI: 1.52 to 59.3). CONCLUSION: Severe hyperglycemia in the first few days after birth is associated with increased odds of death and sepsis in ELBW infants.     

81例超低出生体重儿的临床救治及转归

目的 总结超低出生体重儿(extremely low birth weight infant,ELBWI)的救治及转归特点. 方法 对北京军区总医院附属八一儿童医院2008年10月1日至2011年8月31日收治的81例ELBWI的临床资料进行回顾性分析,卡方检验比较不同胎龄和出生体重ELBWI的救治存活率及病死率. 结果 81例ELBWI中,男43例,女38例,胎龄(28.4±2.1)周,出生体重(903.5±95.4)g.(1)院内发生的合并症和并发症主要有新生儿呼吸窘迫综合征(84.0％,68/81)、动脉导管未闭(58.0％,47/81)、早产儿视网膜病变(50.6％,41/81)、脑室内出血(28.4％,23/81)、支气管肺发育不良(21.0％,17/81)、败血症(18.5％,15/81)、脑室周围白质软化(2.5％,2/81)和新生儿坏死性小肠结肠炎(1.2％,1/81).(2)治疗措施:81例患儿中,96.3％(n=78)曾吸氧,平均用氧时间为19.1d(中位数11d,0～121 d).70.4％(n=57)应用肺表面活性物质,27.2％(n=22)应用经鼻持续气道正压通气,34.6％ (n=28)接受常频机械通气,14.8％(n=12)接受高频机械通气.47例动脉导管未闭患儿均接受布洛芬治疗,其中6例药物治疗无效者手术结扎动脉导管.41例早产儿视网膜病变患儿中的20例接受激光手术.91.4％(n=74例)曾接受全胃肠外营养,平均开奶日龄为5.2d(中位日龄6d,0～17 d),平均达全胃肠道喂养时间为31 d(中位数28 d,7～65 d).(3)转归:81例ELBWI救治存活率65.4％(53/81),放弃治疗率28.4％(23/81),住院病死率6.2％(5/81).胎龄≤26、～28和＞28周的ELBWI的救治存活率逐渐提高[25.0(4/16/)、72.0％(18/25)和77.5％ (31/40)],住院病死率逐渐下降[12.5(2/16)、8.0％ (2/25)和2.5％ (1/40)].出生体重≤800、～900和～1000 g的ELBWI的救治存活率逐渐提高[33.3％(4/12)、58.3％(14/24)和77.8％ (35/45)],住院病死率逐渐降低[16.7(2/12)、8.3％(2/24)和2.2％ (1/45)]. 结论 ELBWI转归与出生胎龄和体重密切相关,专业、精细的治疗有助于提高存活率、改善整体预后.     

超低出生体重儿脑室周围-脑室内出血的危险因素

目的 探讨超低出生体重儿(extremely low birth weight infant,ELBWI)脑室周围-脑室内出血(periventricular-intraventricular hemorrhage,PIVH)的危险因素.方法 研究对象为2001年1月至2008年8月我院新生儿重症监护病房收治的资料完整的ELBWI 41例,其中PIVH23例,无PIVH者18例.采用单因素及Logistic回归分析ELBWI发生PIVH的围产期高危因素.结果 PIVH的发生率为56.1%(23/41).单因素分析显示,PIVH组胎龄小于无PIVH组[(27.1±l.9)周和(28.7±1.6)周](t=2.834,P＜0.05),入院时平均血压低于无PIVH组[(28.9±4.8)mm Hg和(33.1±4.9)mm Hg](t=-2.747,P＜0.05),生后1周内最低平均血压值低于无PIVH组[(24.4±4.3)mm Hg和(31.4±6.6)mm Hg](t=-3.863,P＜0.05),血压波动值和最高PaCO2高于无PIVH组[分别为(19.0±5.2)mm Hg和(13.7±4.8)mm Hg;(60.2±19.4)mm Hg和(49.5±12.1)mm Hg](t分别=3.310和2.166,P均＜0.05);应用肺表面活性物质(73.9%,17/23)、新生儿呼吸窘迫综合征(60.9%,14/23)、休克(52.2%,12/23)、生后4 d内低血压(73.9%,17/23)、1周内高血糖(78.3%,18/23)和机械通气治疗(87.0%,20/23)的比例均高于无PIVH组[分别为27.8%(5/18)、27.8%(5/18)、5.5%(1/18)、33.3%(6/18)、44.5%(8/18)和44.5%(8/18)],差异均有统计学意义(P均＜0.05).Logistic回归分析显示,血压波动值(OR=1.260,95%CI:1.009～1.572,P=0.041)和最低平均血压(OR=0.805,95%CI:0.672～0.965,P=0.019)是PIVH发生的独立危险因素.对接受机械通气治疗的28例ELBWI发生PIVH的危险因素进行Logistic回归分析,结果发现最高吸气峰压(OR=2.086,95%CI:1.140～3.819,P=0.017)是PIVH的独立危险因素.结论 低血压和血压波动是ELBWI发生PIVH的危险因素.对于机械通气的ELBWI,最高吸气峰压过高,可能增加PIVH的发生风险.

Abstract：

Objective To study the risk factors of periventricular-intraventricular hemorrhage (PIVH) in extremely low birth weight infants(ELBWI). Methods A retrospective study was performed in 41 ELBWI hospitalized between January 2001 and August 2008. Univariate analysis and Logistic regression analysis were performed to detect the risk factors of PIVH. Results Of 41ELBWI, twenty-three suffered from PIVH with the incidence of 56.1%. Univariate analysis revealed that,in PIVH group,gestational age,mean blood pressure and the minimum values of blood pressure were lower than non-PIVH group[ ( 27.1 ± 1.9 ) weeks vs ( 28. 7 ± 1.6) weeks, t = 2. 834, P ＜ 0. 05 ;(28.9±4.8) mm Hg vs (33.1±4.9) mm Hg, t=-2.747,P＜0. 05; (24.4±4.3) mm Hg vs (31.4 ± 6.6) mm Hg,t= -3. 863, P＜0. 05], while blood pressure fluctuation and the highest values of PaCO2 during the first week of life were higher[(19.0 ± 5.2) mm Hg vs (13.7 ± 4. 8) mm Hg;(60. 2± 19. 4) mm Hg vs (49.5±12.1) mm Hg] (t= 3. 310 and 2. 166, P＜0. 05), the incidence of administration of pulmonary surfactant, neonatal respiratory distress syndrome, shock, hypotension before 4 days of age, hyperglycemia and mechanical ventilation therapy were higher[73. 9 % (17/23) vs 27. 8%(5/18), 60. 9%(14/23) vs 27.8%(5/18),52. 2%(12/23) vs 5.5%(1/18),73. 9%(17/23) vs 33.3%(6/18) ,78. 3%(18/23) vs 44. 5%(8/18),87. 0% (20/23) vs 44. 5% (8/18)]( all P＜0.05).Multivariate Logistic analysis revealed that blood pressure fluctuation (OR = 1. 260, 95% CI: 1. 009-1. 572, P = 0. 041 ) and lowest mean blood pressure(OR = 0. 805,95 % CI: 0. 672-0. 965, P = 0. 019)were risk factors of PIVH. Among twenty-eight ELBWI received mechanical ventilation, only peakinspiratory pressure(OR=- 2. 086,95% CI: 1. 140-3. 819, P= 0. 017) was the risk factor of PIVH by Logistic analysis. Conclusions Low blood pressure and blood pressure fluctuation may be risk factors of PIVH in ELBWI. The high values of peak inspiratory pressure is a risk factor of ELBWI with mechanical ventilation.     

Improved fluid management utilizing humidified incubators in extremely low birth weight infants.

OBJECTIVE: To compare fluid and electrolyte management in extremely low birth weight (ELBW) infants nursed in humidified versus nonhumidified incubators. STUDY DESIGN: Setting--tertiary intensive care nursery. Subjects--all infants with birth weight < 1000 g admitted 1/95 to 1/99 who were treated with incubators and survived for > 96 hours (N = 155). Intervention--retrospective comparison of daily weights, fluid intakes, urine outputs, and serum electrolytes between group 1 (n = 70, nonhumidified incubators, born 1/95 to 1/97) and group 2 (n = 85, humidified incubators, born 1/97 to 1/99) over the first 4 days after birth. RESULTS: Despite similar daily weight losses between groups, group 1 infants received higher fluid intakes, had lower urine outputs, and had a higher incidence of hypernatremia, hyperkalemia, and azotemia (p < 0.05). Although no differences in mortality or the incidence of patent ductus arteriosus, bronchopulmonary dysplasia, or the overall rate of nosocomial infections were observed, the proportion of gram-negative isolates increased significantly (62%, p < 0.05) following the introduction of humidified incubators. CONCLUSIONS: ELBW weight infants nursed in humidified incubators have lower fluid requirements, improved electrolyte balance, and higher urine outputs during the first 4 days after birth compared to those nursed in nonhumidified incubators.     

Fluconazole prophylaxis in extremely low birth weight infants: association with cholestasis.

BACKGROUND: Extremely low birth weight (ELBW) infants are at increased risk for invasive candidiasis and associated morbidity and mortality. The use of fluconazole prophylaxis in this population has raised a benefit versus risk concern among clinicians. OBJECTIVES: To evaluate the effectiveness and safety of fluconazole prophylaxis in ELBW infants. STUDY DESIGN: ELBW infants (BW相似文献   

Risk factors for tracheostomy requirement in extremely low birth weight infants

Aim: To identify variables that affect the risk of tracheostomy in a population of extremely low birth weight (ELBW) infants.

Methods: A retrospective matched case–control study was conducted. ELBW infants with a tracheostomy were compared with controls without tracheostomy. Data collection included demographics, detailed information about each intubation and extubation attempt, the use of steroids and the presence of comorbidities. Statistical analyses include conditional logistic regression and Poisson regression for clustered observations.

Results: Twenty-eight ELBW infants with a tracheostomy were identified. Mean gestational age for both cases and controls was 25 weeks (22–29) and 67.9% were males. Tracheostomy was performed on average on day of life 118 (95%CI: 107–128) and weight at tracheostomy was 2877?g (95%CI: 2657–3098). In the final model, cumulative days with an endotracheal tube (ETT) and total number of intubation episodes were associated with a tracheostomy. For each additional day of intubation, odds of tracheostomy increased by 11% (OR?=?1.11, 95%CI: 1.01, 1.23) and with each new intubation episode/failed extubation episode, odds of tracheostomy increased by 150% from the previous episode (OR?=?2.5, 95%CI: 1.2, 5.2).

Conclusions: Greater cumulative exposure to ETT ventilation and number of intubations is associated with having a tracheostomy.     

极低和超低出生体重儿败血症临床分析

目的 了解极低和超低出生体重儿败血症临床特点、病原菌分布及药物敏感情况,以指导临床合理用药.方法 对1999年1月1日至2008年12月31日温州医学院附属育英儿童医院新生儿重症监护病房收治的56例极低和超低出生体重儿败血症(早发型败血症3例,晚发型败血症53例)临床特点、血培养结果及药物敏感情况进行回顾性分析.结果 极低和超低出生体重儿败血症临床表现无特征性.血培养结果阳性43例,以条件致病菌为主,其中新生儿早发型败血症血培养阳性1例.为脑膜炎败血黄杆菌;新生儿晚发型败血症血培养病原菌中,革兰阴性细菌主要是肺炎克雷伯菌(33.3%,14/42);革兰阳性细菌以凝固酶阴性葡萄球菌为首(26.2%,11/42),其次是肠球菌(11.9%,5/42);另有真菌感染2例,为白念珠菌败血症(4.8%,2/42).药物敏感试验方面,所有凝固酶阴性葡萄球菌均为耐苯唑西林凝同酶阴性葡萄球菌,对大部分β-内酰胺类抗生素耐药,对林可霉素、氨基糖苷类、大环内酯类及喹诺酮类抗生素亦不敏感,但对万古霉素未发现耐药,对利福平均敏感;所有肺炎克雷伯菌均产超广谱β-内酰胺酶,仅对碳青霉烯类、氨基糖苷类以及喹诺酮类等少数抗生素敏感.56例败血症患儿治愈43例,死亡13例(包括6例病情恶化放弃治疗),病死率为23.2%.结论极低和超低出生体重儿败血症临床表现缺乏特异性,病原菌主要为条件致病菌,并存在多重耐药,对可疑败血症患儿应及时行病原学检查及药物敏感试验,合理选择抗生素.为减少多重耐药菌感染的发生,应正确合理使用第三代头孢菌素.     

Long-distance air medical transport of extremely low birth weight infants with pneumoperitoneum.

OBJECTIVE: Long-distance air transport (LDAT) of infants with pneumoperitoneum for pediatric surgical evaluation has not been previously reported. We examined whether extremely low birth weight (ELBW) infants with and without pneumoperitoneum would tolerate transport differently. STUDY DESIGN: A retrospective cohort study was conducted comparing ELBW infants diagnosed with pneumoperitoneum to other ELBW infants transported>2000 miles by a trained team from a US Department of Defense tertiary care neonatal intensive care unit in Okinawa, Japan. RESULT: Between 2000 and 2006, 49 air transports met study criteria. Seven of the 49 (14%) infants had pneumoperitoneum at time of transport. The average distance flown was 5346 miles per transport. The 49 infants had a median gestational age of 25 weeks and birth weight of 761+/-127 g. ELBW infants without pneumoperitoneum were transported at a median 58 days of life (DOL; range 30 to 91 days) compared to infants with pneumoperitoneum, who were transported at a median 8 DOL (range 6 to 14 days). At the time of LDAT, infants with pneumoperitoneum were significantly smaller, receiving more arterial and central venous access, more pressors for hypotension, and more mechanical ventilation compared to ELBW infants transported without pneumoperitoneum. In-flight patient-related medical issues were similar regardless of underlying diagnosis or age at the time of transport. CONCLUSION: Successful LDAT of ELBW infants, including critically ill infants with intestinal perforation, is possible. Use of personnel, experienced and trained in aviation transport physiology, overcomes the extreme physiologic operating environment associated with LDATs.     

Discharge outcomes of extremely low birth weight infants with spontaneous intestinal perforations.

OBJECTIVE: To examine discharge outcomes of extremely low birth weight infants (ELBW) with spontaneous intestinal perforation (SIP). STUDY DESIGN: A single-center retrospective cohort study of all ELBW infants admitted to the University of Virginia neonatal intensive care unit between July 1996 and June 2004. RESULTS: We found 35 patients with SIP (incidence 8.4%). The median gestational age was 25 weeks, median birth weight was 722 g, and 71% of the infants were male. Most infants (n=28) with SIP were diagnosed secondary to pneumoperitoneum; however, one-third (7) of infants<25 weeks had occult presentations without pneumoperitoneum. When controlled for gestational age, gender, multiple gestation, indomethacin, and glucocorticoid exposure, infants with SIP have a higher risk of PVL and death than infants without perforation. SUMMARY: Periventricular leukomalacia and death are significantly associated with SIP in ELBW after adjusting for gestational age, multiple gestation, indomethacin, and glucocorticoid exposure.     

救治12例超低出生体重儿体会

目的探讨在新生儿重症监护病房（neonatal intensive care unit，NICU）救治超低出生体重儿（extremely low birth weight infant，ELBWI）的过程中，不断提高存活率及减少后遗症的关键问题。方法对于2000年1月至2006年4月间我院收治的12例ELBWI的临床资料进行回顾性分析，总结救治工作的经验体会。结果（1）近3年ELBWI存活率（4／5）较前4年（4／7）明显增高；救治成活者最小胎龄25周，出生体重650g。（2）支气管肺发育不良、颅内出血和脑室周围白质软化等是造成严重后遗症的主要原因；呼吸、感染、内环境紊乱仍是ELBWI死亡的主要原因。（3）近3年没有出现早产儿视网膜病、新生儿坏死性小肠结肠炎、核黄疸等ELBWI易发生的并发症。结论ELBWI的管理是一个系统工程，一个团队整体水平的体现，既要提高存活率又要提高患儿的生存质量。因此，必须注重产前、产时及出生后产、儿科的密切配合；对ELBWI的护理工作要精细；积极防治各种并发症。在治疗过程中努力争取患儿家人的理解与合作。出院后将ELBWI纳入高危儿管理系统是保证其生存质量的关健。     

The epidemiology of atypical chronic lung disease in extremely low birth weight infants.

OBJECTIVE: To determine the incidence and associated complications of atypical chronic lung disease (ACLD) in extremely low birth weight infants. STUDY DESIGN: All infants born at Johns Hopkins Hospital between 1996 and 2001, with birthweight <1000 g, gestational age <31 weeks, no major anomalies or genetic syndromes, and living at least 21 days were eligible for inclusion. Data pertaining to demographics, hospital course, diagnosis of atypical chronic lung disease, patterns of surfactant use, complications of prematurity and severity of lung disease were collected. RESULT: Using inclusion criteria, 215 eligible infants were identified, of which 185 had hospital charts available for review. Twenty-eight infants (15%) met the criteria for atypical chronic lung disease. Of the remaining 157 infants, 57 patients met the criteria for mild bronchopulmonary dysplasia (BPD) (supplemental oxygen requirement at 28 days of life), 38 patients had moderate/severe BPD (supplemental oxygen requirement at both 28 days of life and 36 weeks post-menstrual age), and 38 infants did not have chronic lung disease. Infants with ACLD had much higher rates of sepsis (46%) and pneumothorax (18%) than infants in the comparison groups. CONCLUSION: Infants with respiratory distress syndrome in the first week of life, which initially resolves are still at risk for an atypical form of chronic lung disease. The prolonged respiratory support they require as a result of this type of lung disease increases their risk for complications of prematurity, which may outlast their lung disease. We speculate that inflammation secondary to infection acquired shortly after birth may be an important step in the pathogenesis of ACLD.     

A comparison of statistical outcome variables in extremely low birth weight infants

Three different summary statistics of developmental outcome are described. These include the "handicap ratio" (handicapped individuals divided by survivors), the "handicap rate" (handicapped individuals divided by live births for that birth weight group), and the "handicaps per 10,000 live births" (handicapped individuals divided by 10,000 live births for a geographic region). An analysis of these statistics was undertaken using a sample of extremely low birth weight (ELBW) (less than 1,001 g) infants born in Hawaii during the period of 1975-1981. The results of this study showed a poor correlation between these summary statistics. The results suggest that these statistics represent different aspects of outcome in the ELBW infant. Suitable uses for each of these variables is discussed.