945 Clinical audit on prevalence of bronchopulmonary dysplasia in a level 3 NICU

• Published in: Archives of disease in childhood Vol. 108; no. Suppl 2; pp. A171 - A172
• Main Authors: Jayasekara, Shiranthi, Gbinigie, Helen, Mnohar, Dinesh, Thangathurai, PA Keerthika
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2023
• Subjects: Birth weight; Blood culture; Body Weight; Breast milk; Budesonide; Chorioamnionitis; Corticoids; Corticosteroids; Data collection; Diuretics; Dysplasia; Extubation; Hydrocortisone; Infants; Intensive care; Intolerance; Low birth weight; Lung diseases; Mechanical ventilation; Menstruation; Meta Analysis; Morbidity; Neonatal care; Neonates; Newborn babies; Patients; Pediatrics; Pregnancy; Premature babies; Premature birth; Premature Infants; Steroid hormones; Steroids; Surfactants; Ventilation; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.273

ObjectivesBronchopulmonary dysplasia(BPD) is a chronic lung disease especially among the preterm babies with high morbidity and mortality. The objectives are to assess the incidence of BPD and to identify patient characteristics and contributory factors with aims to identify potentially better care practices to reduce the number of babies affected by BPD.MethodsRetrospective data collection over 7 years from 2013 to 2019 of all the eligible babies in the NICU who were less than 32 weeks gestation at birth with respiratory support at 36 weeks post-menstrual age. The data Collection was from BaderNet, patient notes and iLab.ResultsThe incidence among boys outweighed the girls, 58.7% vs 41.2%. The majority were 500–1000g, 57.6% followed by 1000–1500g of 30%. Ex-preterms<28 weeks were highest 61% followed by 28–32 weekers of 37.9%. 30% were twins and 23.2% were IUGR.10.73% were delivered by mothers with PIH while 5.65% with DM. 11.3% had a background of chorioamnionitis & 7.34% maternal UTI; total perinatal infections of 19%.20.9% were exposed to smoking in utero.90.4% received at least 1 dose of antenatal steroids.84% had admission temperature within normal and 84.2% had surfactant administered. Among the respiratory data, 90% received invasive ventilation with an average of 22 ventilation days. 59.4% of babies were on VG mode, 26.8% on HFOV. 100% of the babies had non-invasive ventilation at some point and the average number of days was 32.47.5% had high CRPs while 16% had >100. 24.4% had culture +ve ETT, 41.8% blood culture positive, 5.8% developing pneumonia.49.2% received postnatal steroids ( 23.8% Hydrocortisone, 25.4% Budesonide) and 49.2% received none.73.4% had diuretics, 68.3% for respiratory reasons while 16% had for cardiac reasons, 26.6% didn’t receive any.51.3% had a PDA ( 26.4% moderate, 7.9% large sized, 1.6% small while 64.1% not recorded). 40.7% with PDA received treatment with 53% within 1st week of life.69% had poor weight gain and 35% had MBD. 35.6% received breast milk fortifier while 65% suffered feed intolerance. (Chart 1 shows MBD and weight gain)53.7% went on home O2 while 40% went without. 1.7% had died before discharge.ConclusionsExtreme preterm and low birth weight babies were among the highest risk. Invasive ventilation largely contributed to the risk of BPD while infection, PDA, poor weight gain, MBD too played a major role. The burden of home oxygen was among half of the BPD population.ReferencesFischer HS, Buhrer C. Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta-analysis. Pediatrics 2018;132:e1351-e1360.Bhandari V. The potential of non-invasive ventilation to decrease BPD. Semin Perinatol. 2018;37:108–114.Paed chi heal. B, Dunn M,Thebaud B: Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia in preterm infants. 2020;25(5):322–326.Jensen EA, DeMauro B, Kornhauser M, Greenspan JS, KC D Effects of multiple ventilation courses and duration of mechanical ventilation on respiratory outcomes in extremely low-birth-weight infants. JAMAPediatr. 2015;169:1011–1017.Robbins M, Trittmann J, Martin E, Reber KM, Nelin L, E Shepherd Early extubation attempts reduce length of stay in extremely preterm infants even if re-intubation is necessary. J Neonat Perinat Med. 2015;8:91–97.Berger J, Mehta P, Bucholz E, Dziura J, Early extubation and reintubation on the incidence of bronchopulmonary dysplasia in neonates. Am J Perinatol. 2014;31:1063–1072.Bhuta T, Henderson-Smart DJ: Elective HFOV versus conventional ventilation in preterm infants with pulmonary dysfunction: systematic review and meta-analyses. Pediatrics. 100:E6-E7.Garland JS, Buck RK, Allred EN, et al: Hypocarbia before surfactant therapy appears to increase brocho- pulmonary dysplasia risk in infants with respiratory dis- tress syndrome. Arch Pediatr Adolesc Med 149:61%622.Abstract 945 Figure 1