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5ICCN_014: Bronchopulmonary dysplasia epidemic in premature infants in Bogota, Colombia
5th International Conference on Clinical Neonatology – Selected conference abstracts / Early Human Development 90S2 (2014) S61–S79
weighed more than 2000 g. 28.9% of patients were less than 30 weeks of GA, 50.8% were less than 32 and even 4.3% were more than 37 weeks of GA. Post-natal age at entry was between 1–15 days for 28.1%, 15–30 days for 30.5% and more than 1 month for 41.4% of them. 68.2% were NICU graduates, 42.8% of them have been ventilated. 40.6% were diagnosed with BPD at entry and 11.6% had intraventricular hemorrhage. 17.9% had history of nosocomial infection at entry. Lost of follow up was 21.3% from entry into KMC to one year of corrected age. Overall mortality in the cohort was 1.5% up to one year, with 11.7% of deaths occurring between discharge and 3 months. 15.4% of infants were readmitted at least once. Main cause of readmission before 3 months was acute respiratory infection (51%). In average, oxygen was discontinued at 94 days of chronological age and with an average weight of 4066 g. 44% received exclusive breastfeeding up to term, 26% up to three months and 51.2% received mix feeding at 3 months of corrected age. Average weight, length and head circumference were 2905 g, 47.6 cm, 34.6 cm at term and 8630 g, 71.7 cm and 45.7 cm at one year of corrected age; Retinopathy was detected in 8.7%, laser surgery 2.3% and blindness in 0.2%. Abnormal audiometry results were found in 3.3% of children. Risk of cerebral palsy at one year was 5.1%. Mean developmental coefficient at 6 months was 93.1 and at 12 months 94.2 (Griffiths + Bailey II behavioral subscale). Our experience shows that weight, over age, is a major indicator of oxygen discontinuation. Weaning in our cohort reached its peak at 3431 g. There is an unacceptable rate of OD in infants >32 weeks GA that may be explained by inappropriate ventilation practices in NICUs, suboptimal oxygen delivery and factors that need to be further explored in prospective studies. 5ICCN_014 Bronchopulmonary dysplasia epidemic in premature infants in Bogota, Colombia J.G. Ruiz-Pelaez ´ 1 , N. Charpak2 , L. Rosero3 . 1 Departament of Clinica Epidemiology and Biostatistics; Peadiatrics Department, Pontificia Universidad Javeriana. Hospital Universitario San Ignacio, 2 Kangaroo Foundation, 3 Kangaroo Mother Care Program, Hospital Universitario San Ignacio, Bogota, Colombia
suboptimal aggressive respiratory care practices associated with a recent transition from restricted to almost universal access to mechanical ventilation in neonatal intensive care units in Bogota´ might be compromising the quality of neonatal respiratory care. 5ICCN_015 The association of early postnatal weight loss with outcome in extremely low birth weight infants H. Tatar Aksoy1 , N. Guzo˘ ¨ glu1 , Z. Eras1 , I˙ .K. Gok ¨ ce ¸ 1 , F.E. Canpolat1 , 1 1 1,2 1 N. Uras¸ , S.S. O˘guz , U. Dilmen . Zekai Tahir Burak Maternity and Teaching Hospital, Neonatal Intensive Care Unit, 2 Yıldırım Beyazıt University School of Medicine, Department of Pediatrics, Ankara, Turkey Keywords: ELBW; Weight loss; Mortality Objective: To compare outcomes of extremely low birth weight (ELBW) infants having different weight losses in the first 3 days of life. 126 ELBW infants were evaluated retrospectively for weight loss percentages on the third day of life compared to their birth weight. We examined the weight loss on the third day of life compared to the birth weight for the ELBW infants and tested its association with mortality and morbidities. The mortality was subgrouped as overall mortality and mortality in the first 7 days of life. The morbidities were patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD). We grouped the infants into four quartiles according to weight loss percentage on the third day of life as Group 1 (Quartile 1), infants with weight loss between 0–3% of birth weight; Group 2 (Quartile 2), infants with weight loss between 3.1–7.5%; Group 3 (Quartile 3), infants with weight loss between 7.51–12%; and Group 4 (Quartile 4), infants with weight loss more than 12%. The mortality and morbidities were analyzed according to these groups and other risk factors. Infants having less than 3% (Group 1) or more than 12% (Group 4) weight loss were analyzed as an inappropriate weight loss group. Infants having 3–12% (Groups 2 and 3) weight loss were analyzed as an appropriate weight loss group. Table 1. Demographic characteristics of patients
Keywords: Premature; Infant; Kangaroo Mother Care; Bronchopulmonary dysplasia; Epidemiology Objective: Estimating the actual BPD incidence, comparing it with historical data and describing associated factors. Prospective analytical cohort study. Setting: Twelve neonatal intensive care units in Bogota´ in 2004. Participants: Preterm newborns ≤34 weeks of gestational age without major malformations. Main outcomes: Incidence and severity of BPD. Comparison with an historical cohort. Factors associated with current incidence. Neonatal mortality was 80/496, and the BPD incidence was 54.3% (95% CI, 49.4–59.1). When controlling for type of institution (low and high mortality) it appeared that being born in an institution with low mortality decreased the risk for death (OR, 0.308; 95% CI, 0.129–0.736) but increased the odds for moderate–severe BPD (OR, 1.797; 95% CI, 1.046–3.088). The risk for BDP was higher than for the historical control cohort (RR, 1.924; 95% CI, 1.686–2.196). Weight and gestational age at birth, mechanical ventilation, intrauterine growth restriction and type of institution (low vs. intermediate–high mortality) were independently associated with BPD of increasing severity or even death. The frequency of BPD in Bogota´ has increased markedly, and this cannot be explained solely by better survival of more fragile infants. Although these fragile infants survive more often when born at ‘low-mortality’ institutions, they have more frequent and more severe respiratory sequels. Probably
S67
Gestational age (weeks), mean±SD Birth weight (g), mean±SD Gender (M/F) Low APGAR Yes No Preeclampsia Yes No Oligohydramnios Yes No Polyhydramnios Yes No PPROM Yes No SGA Yes No Diabetes mellitus Yes No
Groups 1 and 4 (n = 64)
Groups 2 and 3 (n = 62)
p
26.6±2.2 819±184 33/31
26.9±2.3 839±119 35/27
0.44 0.24 0.59 0.58
29 (45.2%) 35 (54.8%)
32 (51.8%) 30 (48.2%)
17 (26.6%) 47 (73.4%)
17 (27.4%) 45 (72.6%)
11 (17.2%) 53 (82.8%)
9 (14.5%) 53 (85.5%)
3 (4.7%) 61 (95.3%)
2 (3.2%) 60 (96.8%)
9 (14.1%) 55 (85.9%)
8 (12.9%) 54 (87.9%)
15 (23.4%) 49 (76.6%)
9 (14.5%) 53 (85.5%)
1 (1.6%) 63 (98.4%)
3 (4.9%) 58 (95.1)
1.00
0.80
1.00
1.00
0.25
0.35
Demographic characteristics of patients were not different between the groups (Table 1). Overall mortality and mortality in the first 7 days of life were significantly higher in Groups 1 (36% and 27%) and 4 (43% and 24%), compared to Groups
weighed more than 2000 g. 28.9% of patients were less than 30 weeks of GA, 50.8% were less than 32 and even 4.3% were more than 37 weeks of GA. Post-natal age at entry was between 1–15 days for 28.1%, 15–30 days for 30.5% and more than 1 month for 41.4% of them. 68.2% were NICU graduates, 42.8% of them have been ventilated. 40.6% were diagnosed with BPD at entry and 11.6% had intraventricular hemorrhage. 17.9% had history of nosocomial infection at entry. Lost of follow up was 21.3% from entry into KMC to one year of corrected age. Overall mortality in the cohort was 1.5% up to one year, with 11.7% of deaths occurring between discharge and 3 months. 15.4% of infants were readmitted at least once. Main cause of readmission before 3 months was acute respiratory infection (51%). In average, oxygen was discontinued at 94 days of chronological age and with an average weight of 4066 g. 44% received exclusive breastfeeding up to term, 26% up to three months and 51.2% received mix feeding at 3 months of corrected age. Average weight, length and head circumference were 2905 g, 47.6 cm, 34.6 cm at term and 8630 g, 71.7 cm and 45.7 cm at one year of corrected age; Retinopathy was detected in 8.7%, laser surgery 2.3% and blindness in 0.2%. Abnormal audiometry results were found in 3.3% of children. Risk of cerebral palsy at one year was 5.1%. Mean developmental coefficient at 6 months was 93.1 and at 12 months 94.2 (Griffiths + Bailey II behavioral subscale). Our experience shows that weight, over age, is a major indicator of oxygen discontinuation. Weaning in our cohort reached its peak at 3431 g. There is an unacceptable rate of OD in infants >32 weeks GA that may be explained by inappropriate ventilation practices in NICUs, suboptimal oxygen delivery and factors that need to be further explored in prospective studies. 5ICCN_014 Bronchopulmonary dysplasia epidemic in premature infants in Bogota, Colombia J.G. Ruiz-Pelaez ´ 1 , N. Charpak2 , L. Rosero3 . 1 Departament of Clinica Epidemiology and Biostatistics; Peadiatrics Department, Pontificia Universidad Javeriana. Hospital Universitario San Ignacio, 2 Kangaroo Foundation, 3 Kangaroo Mother Care Program, Hospital Universitario San Ignacio, Bogota, Colombia
suboptimal aggressive respiratory care practices associated with a recent transition from restricted to almost universal access to mechanical ventilation in neonatal intensive care units in Bogota´ might be compromising the quality of neonatal respiratory care. 5ICCN_015 The association of early postnatal weight loss with outcome in extremely low birth weight infants H. Tatar Aksoy1 , N. Guzo˘ ¨ glu1 , Z. Eras1 , I˙ .K. Gok ¨ ce ¸ 1 , F.E. Canpolat1 , 1 1 1,2 1 N. Uras¸ , S.S. O˘guz , U. Dilmen . Zekai Tahir Burak Maternity and Teaching Hospital, Neonatal Intensive Care Unit, 2 Yıldırım Beyazıt University School of Medicine, Department of Pediatrics, Ankara, Turkey Keywords: ELBW; Weight loss; Mortality Objective: To compare outcomes of extremely low birth weight (ELBW) infants having different weight losses in the first 3 days of life. 126 ELBW infants were evaluated retrospectively for weight loss percentages on the third day of life compared to their birth weight. We examined the weight loss on the third day of life compared to the birth weight for the ELBW infants and tested its association with mortality and morbidities. The mortality was subgrouped as overall mortality and mortality in the first 7 days of life. The morbidities were patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD). We grouped the infants into four quartiles according to weight loss percentage on the third day of life as Group 1 (Quartile 1), infants with weight loss between 0–3% of birth weight; Group 2 (Quartile 2), infants with weight loss between 3.1–7.5%; Group 3 (Quartile 3), infants with weight loss between 7.51–12%; and Group 4 (Quartile 4), infants with weight loss more than 12%. The mortality and morbidities were analyzed according to these groups and other risk factors. Infants having less than 3% (Group 1) or more than 12% (Group 4) weight loss were analyzed as an inappropriate weight loss group. Infants having 3–12% (Groups 2 and 3) weight loss were analyzed as an appropriate weight loss group. Table 1. Demographic characteristics of patients
Keywords: Premature; Infant; Kangaroo Mother Care; Bronchopulmonary dysplasia; Epidemiology Objective: Estimating the actual BPD incidence, comparing it with historical data and describing associated factors. Prospective analytical cohort study. Setting: Twelve neonatal intensive care units in Bogota´ in 2004. Participants: Preterm newborns ≤34 weeks of gestational age without major malformations. Main outcomes: Incidence and severity of BPD. Comparison with an historical cohort. Factors associated with current incidence. Neonatal mortality was 80/496, and the BPD incidence was 54.3% (95% CI, 49.4–59.1). When controlling for type of institution (low and high mortality) it appeared that being born in an institution with low mortality decreased the risk for death (OR, 0.308; 95% CI, 0.129–0.736) but increased the odds for moderate–severe BPD (OR, 1.797; 95% CI, 1.046–3.088). The risk for BDP was higher than for the historical control cohort (RR, 1.924; 95% CI, 1.686–2.196). Weight and gestational age at birth, mechanical ventilation, intrauterine growth restriction and type of institution (low vs. intermediate–high mortality) were independently associated with BPD of increasing severity or even death. The frequency of BPD in Bogota´ has increased markedly, and this cannot be explained solely by better survival of more fragile infants. Although these fragile infants survive more often when born at ‘low-mortality’ institutions, they have more frequent and more severe respiratory sequels. Probably
S67
Gestational age (weeks), mean±SD Birth weight (g), mean±SD Gender (M/F) Low APGAR Yes No Preeclampsia Yes No Oligohydramnios Yes No Polyhydramnios Yes No PPROM Yes No SGA Yes No Diabetes mellitus Yes No
Groups 1 and 4 (n = 64)
Groups 2 and 3 (n = 62)
p
26.6±2.2 819±184 33/31
26.9±2.3 839±119 35/27
0.44 0.24 0.59 0.58
29 (45.2%) 35 (54.8%)
32 (51.8%) 30 (48.2%)
17 (26.6%) 47 (73.4%)
17 (27.4%) 45 (72.6%)
11 (17.2%) 53 (82.8%)
9 (14.5%) 53 (85.5%)
3 (4.7%) 61 (95.3%)
2 (3.2%) 60 (96.8%)
9 (14.1%) 55 (85.9%)
8 (12.9%) 54 (87.9%)
15 (23.4%) 49 (76.6%)
9 (14.5%) 53 (85.5%)
1 (1.6%) 63 (98.4%)
3 (4.9%) 58 (95.1)
1.00
0.80
1.00
1.00
0.25
0.35
Demographic characteristics of patients were not different between the groups (Table 1). Overall mortality and mortality in the first 7 days of life were significantly higher in Groups 1 (36% and 27%) and 4 (43% and 24%), compared to Groups