Chronic lung disease in very low birthweight infants: a 5-year review.

OBJECTIVES

To determine the incidence, clinical spectrum and outcome of very low birthweight (VLBW) infants with chronic lung disease (CLD), and evaluate associated factors.

METHODOLOGY: Retrospective review of 265 VLBW infants managed in the NICU from January 1988 to December 1992.

RESULTS

The overall neonatal survival rate for VLBW infants was 83%. Sixty-five (25%) infants had CLD, of whom 42% had severe CLD. Mortality in infants with CLD was 11%. In contrast with infants without CLD, CLD infants had significantly higher risk of adverse neurodevelopment with cerebral palsy documented in 13.5% and functional disability recorded in 34.6% at 2 years corrected age. Factors associated with the development of CLD included; decreasing birthweight (OR 0.98, CI 0.97-0.99), septicaemia (OR 4.96, CI 1.57-15.65), necrotizing enterocolitis (OR 119.07, CI 4.98-2845.04), hyaline membrane disease (OR 5.34, CI 1.83-15.55), patent ductus arteriosus (OR 4.46, CI 1.75-11.36) and increasing fraction of inspired oxygen concentration in the first week of life (OR 1.09, CI 1.04-1.14).

CONCLUSIONS

Chronic lung disease occurs frequently in VLBW infants and is associated with a high incidence of adverse neurodevelopment. Further studies to clarify the role of non-respiratory factors such as patent ductus arteriosus (PDA) and sepsis in the pathogenesis of CLD may reduce the incidence or prevent the development of CLD in these preterm infants.