Impaired Growth at Birth and Bronchopulmonary Dysplasia Classification: Beyond Small for Gestational Age

Abstract

Objective To correlate intrauterine and postnatal growth with bronchopulmonary dysplasia (BPD) classification at 36 weeks postmenstrual age (PMA).

Study Design A retrospective cohort design reviewing medical records for infants < 29 weeks gestational age (GA) born between 2008 and 2010. BPD classification using physiological definition at 36 weeks PMA and growth parameters at birth and 36 weeks PMA were compared between GA subgroups.

Results The cohort consisted of 140 infants. Median GA and birth weight (BW) were 27 weeks and 918 g, respectively. Twenty percent of infants had no BPD, 27% had mild BPD, 31% had moderate BPD, and 22% had severe BPD. While BW and GA remain major factors associated with severe BPD, we did not observe differences in weights at 36 weeks PMA. Length and head circumference were significantly impaired in infants born < 26 weeks GA at birth and 36 weeks PMA. Most importantly, all infants born < 26 weeks GA below the 25th percentile for weight developed moderate/severe BPD.

Conclusion Infants born < 26 weeks GA were smaller at birth and had significant postnatal growth impairment in linear and head circumference growth. Risk of developing BPD associated with lower BW for GA appeared to occur beyond the traditional small-for-gestational age (SGA) classification.

Keywords

bronchopulmonary dysplasia - growth restriction - ponderal index - extremely low birth weight

• References

• 1 Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth. N Engl J Med 2008; 359 (3) 262-273
• 2 Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA. NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birthweight infants. Pediatrics 2007; 196: 147
• 3 Finer NN, Carlo WA, Walsh MC , et al. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010; 362 (21) 1970-1979
• 4 Biniwale MA, Ehrenkranz RA. The role of nutrition in the prevention and management of bronchopulmonary dysplasia. Semin Perinatol 2006; 30 (4) 200-208
• 5 Ehrenkranz RA, Walsh MC, Vohr BR , et al. National Institutes of Child Health and Human Development Neonatal Research Network. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005; 116 (6) 1353-1360
• 6 Zeitlin J, El Ayoubi M, Jarreau PH , et al. MOSAIC Research Group. Impact of fetal growth restriction on mortality and morbidity in a very preterm birth cohort. J Pediatr 2010; 157 (5) 733-739 , e1
• 7 Bose C, Van Marter LJ, Laughon M , et al. Extremely Low Gestational Age Newborn Study Investigators. Fetal growth restriction and chronic lung disease among infants born before the 28th week of gestation. Pediatrics 2009; 124 (3) e450-e458
• 8 Yu HJ, Kim ES, Kim JK , et al. Outcomes of small for gestational age micropremies depending on how young or how small they are. Korean J Pediatr 2011; 54 (6) 246-252
• 9 Piper JM, Xenakis EM, McFarland M, Elliott BD, Berkus MD, Langer O. Do growth-retarded premature infants have different rates of perinatal morbidity and mortality than appropriately grown premature infants? . Obstet Gynecol 1996; 87 (2) 169-174
• 10 Regev RH, Lusky A, Dolfin T, Litmanovitz I, Arnon S, Reichman B ; Israel Neonatal Network. Excess mortality and morbidity among small-for-gestational-age premature infants: a population-based study. J Pediatr 2003; 143 (2) 186-191
• 11 Sharma P, McKay K, Rosenkrantz TS, Hussain N. Comparisons of mortality and pre-discharge respiratory outcomes in small-for-gestational-age and appropriate-for-gestational-age premature infants. BMC Pediatr 2004; 4: 9
• 12 Truog WE, Nyp MF, Taylor J , et al. Infants born at < 29 weeks: pulmonary outcomes from a hybrid perinatal system. J Perinatol 2014; 34 (1) 59-63
• 13 Natarajan G, Pappas A, Shankaran S , et al. Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia: impact of the physiologic definition. Early Hum Dev 2012; 88 (7) 509-515
• 14 Benaron DA, Benitz WE. Maximizing the stability of oxygen delivered via nasal cannula. Arch Pediatr Adolesc Med 1994; 148 (3) 294-300
• 15 Peacock JL, Lo JW, D'Costa W, Calvert S, Marlow N, Greenough A. Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely. Pediatr Res 2013; 73 (4, Pt 1) 457-463
• 16 Barker DJ, Osmond C, Law CM. The intrauterine and early postnatal origins of cardiovascular disease and chronic bronchitis. J Epidemiol Community Health 1989; 43 (3) 237-240
• 17 Olsen IE, Lawson ML, Meinzen-Derr J , et al. Use of a body proportionality index for growth assessment of preterm infants. J Pediatr 2009; 154 (4) 486-491
• 18 Nguyen TT, Hoo AF, Lum S, Wade A, Thia LP, Stocks J. New reference equations to improve interpretation of infant lung function. Pediatr Pulmonol 2013; 48 (4) 370-380
• 19 Wemhöner A, Ortner D, Tschirch E, Strasak A, Rüdiger M. Nutrition of preterm infants in relation to bronchopulmonary dysplasia. BMC Pulm Med 2011; 11: 7
• 20 Dani C, Poggi C. Nutrition and bronchopulmonary dysplasia. J Matern Fetal Neonatal Med 2012; 25 (Suppl. 03) 37-40
• 21 Theile AR, Radmacher PG, Anschutz TW, Davis DW, Adamkin DH. Nutritional strategies and growth in extremely low birth weight infants with bronchopulmonary dysplasia over the past 10 years. J Perinatol 2012; 32 (2) 117-122
• 22 Madden J, Kobaly K, Minich NM, Schluchter M, Wilson-Costello D, Hack M. Improved weight attainment of extremely low-gestational-age infants with bronchopulmonary dysplasia. J Perinatol 2010; 30 (2) 103-111
• 23 Laughon MM, Langer JC, Bose CL , et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants. Am J Respir Crit Care Med 2011; 183 (12) 1715-1722