[Bronchopulmonary dysplasia: outcome and treatment of severe forms].

BACKGROUND

The outcome of severe forms of bronchopulmonary dysplasia (BPD) leading to a prolonged dependence on mechanical ventilation (MV) and/or oxygen therapy (O2) is not evaluated, and factors of guidance to treatment are not established.

POPULATION AND

METHODS

The medical records of 49 infants, born between 1982 and 1990, with BPD who required MV and or O2 after 12 months of life were retrospectively reviewed. Three groups of infants were defined: group I: 26 infants on MV since birth; group II: seven infants weaned from MV after the first month of life then put back on MV belatedly; group III: 16 infants on spontaneous ventilation (SV) under O2.

RESULTS

At 12 months of age, the 49 infants showed sleep hypoxemia, failure to thrive and 28% of them pulmonary hypertension. Comparison between MV and O2 infants indicated that subjects on MV had pulmonary dynamic compliance (Cl dyn) lower than 50% (p = 0.01), ventilatory work including respiratory frequency in rest > 40 cycles/min; 70% of them had asynchronous thoracic and abdominal muscles during sleep (p < 0.01 for all comparisons). Seventy percent of patients had bronchospasms (p = 0.02). The 49 infants had a favourable outcome, allowing weaning from MV or O2 between the ages of 2 and 4 years.

CONCLUSIONS

These findings suggest that major respiratory failure in prematurely born infants can be overcome with prolonged respiratory and nutritional supports during the post-natal period of lung development; Cl dyn < 50% is a cursor for prolonged MV and weaning from MV should be excluded as long as increased ventilatory work persists.