Journal Article

Bronchopulmonary dysplasia precursors influence risk of white matter injury and adverse neurodevelopmental outcome in preterm infants

Partridge, J. Colin, Grelli, Kimberly N., Rogers, Elizabeth E., Xu, Duan, Keller, Roberta L., Gano, Dawn, Barkovich, A. James

2021

Overview

Background Cumulative supplemental oxygen (CSO) and cumulative mean airway pressure (CMAP) are associated with bronchopulmonary dysplasia (BPD) in preterm infants, but their relationships to white matter injury (WMI) and neurodevelopment have not been evaluated. Methods Preterm infants <32 weeks’ gestation were prospectively imaged with 3 T MRI near term. CSO and CMAP were retrospectively summed over the first 14 and 28 days. Neurodevelopment was assessed at 30 months adjusted using the Bayley-III. ROC and linear regression were used to evaluate the relationship between CSO, CMAP, and BPD with WMI and neurodevelopmental performance, respectively. Results Of the 87 infants, 30 (34.5%) had moderate–severe BPD, which was associated with WMI (OR 5.5, 95% CI 1.1–34.9, p  = 0.012). CSO and CMAP predicted WMI as well as BPD (AUC 0.68–0.77). CSO was independently associated with decreased language and cognitive performance (mean difference at 14 days: −11.0, 95% CI −19.8 to −2.2, p  = 0.015 and −9.8, 95% CI −18.9 to −0.7, p  = 0.035, respectively) at 30 months adjusted. Conclusions BPD precursors predict WMI as well as BPD. Cumulative supplemental oxygen over the first 14 days of life is independently associated with lower language and cognitive performances. These data suggest that early respiratory status influences the risk of adverse neurodevelopment in preterm infants. Impact Respiratory precursors to bronchopulmonary dysplasia (BPD), cumulative supplemental oxygen and mean airway pressure, over the first 14–28 days performed as well as BPD for the prediction of white matter injury on MRI in preterm infants. Cumulative supplemental oxygen was independently associated with lower language and cognitive performance on the Bayley-III at 30 months adjusted. These data suggest that early respiratory status may help explain why BPD is independently associated with adverse neurodevelopmental outcomes in the preterm population and highlights the importance of interventions targeting respiratory status as a potential avenue to improve neurodevelopmental outcomes.

• Publisher: Nature Publishing Group US,Nature Publishing Group
• Subject: Age Factors / Bronchopulmonary Dysplasia - diagnosis / Bronchopulmonary Dysplasia - etiology / Bronchopulmonary Dysplasia - physiopathology / Child Development / Child Language / Child, Preschool / Clinical Research Article / Cognition / Cross-Sectional Studies / Gestational Age / Humans / Infant, Newborn / Infant, Premature / Leukoencephalopathies - diagnostic imaging / Leukoencephalopathies - etiology / Leukoencephalopathies - physiopathology / Lung - physiopathology / Lung diseases / Magnetic Resonance Imaging / Medicine / Medicine & Public Health / Motor Activity / Nervous System - diagnostic imaging / Nervous System - growth & development / Newborn babies / Oxygen Inhalation Therapy - adverse effects / Pediatric Surgery / Pediatrics / Predictive Value of Tests / Premature babies / Pressure / Respiration / Retrospective Studies / Risk Assessment / Risk Factors / Time Factors