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In the 1990's, increasing use of antenatal steroid and routine surfactant therapy has enabled us to wean infants off of ventilatory support at much earlier postnatal ages. Even infants with <800 gm birth weight are often weaned to very low ventilatory settings or extubated in the first week of age. Yet, it is unclear whether such early improvement in pulmonary status is sustained during the rest of the first month. It is also unclear if this results in a lowered BPD rate (defined as O2 dependency on the 28th day). To test this, we reviewed the medical records of 613 infants who had respiratory distress and were admitted to NICU. They were born between Jan 1988 through June 1994. The other inclusion criteria was that they should have survived for at least 14 days. Several maternal and neonatal variables were analyzed, including survival rate, oxygen requirement (days) and ventilatory dependency. The data for 305 infants born 1988-91 (Period A) were combined with those of 306 infants born 1992-94 (Period B). Results: For the infants <1 Kg birth weight, the mean (SD) duration of ventilatory support in Period A was 48(28) days and in Period B 39 (29) days. The respective rates for infants>1 Kg were: 13(13) in Period A, and 13(15) days in Period B. In <1 Kg infants, the mean duration of O2 dependency in Period A was 70(45.6) days and in Period B 63(43); the respective rates for >1 Kg infants were 13(25) in Period A and 19(27) days in Period B. Other data are in the Table. Summary and Conclusions In <1 Kg infants, there was a slight reduction in the overall duration of assisted ventilation in Period B. However, neither the overall duration of O2 requirement nor the rate of BPD (as defined above) changed significantly over the time course. It appears that the impact of antenatal steroid and surfactant is far greater on the early course of preterm infant's lung disease rather than on the course later during the first month.
Fiumara, A., Raju, T. The Changing Profile of Bronchopulmonary Dysplasia (BPD) between 1988 and 1994 † 1249.
Pediatr Res43
(Suppl 4), 214 (1998). https://doi.org/10.1203/00006450-199804001-01270
