Am J Perinatol 2020; 37(S 02): S89-S100
DOI: 10.1055/s-0040-1716978
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Incidence of Bronchopulmonary Dysplasia Following Extremely Premature Birth and Associated Mortality Rates and Medication Use: Findings from a Large Integrated Health Care Delivery System in the United States

De-kun Li
1   Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, California
,
Andrew Hirst
1   Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, California
,
Sujata Sarda
2   Global Evidence and Outcomes, Data Sciences Institute, Shire (a Takeda company), Lexington, Massachusetts
,
Jeannette Ferber
1   Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, California
,
Michael Kuzniewicz
1   Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, California
,
Csaba Siffel
2   Global Evidence and Outcomes, Data Sciences Institute, Shire (a Takeda company), Lexington, Massachusetts
3   Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, Georgia
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Publikationsverlauf

Publikationsdatum:
08. September 2020 (online)

 
 

    Introduction Extremely premature (EP) birth (<28 weeks’ gestational age [wGA]) is a major cause of mortality and morbidity in children. A major complication of EP birth is bronchopulmonary dysplasia (BPD). Incidence estimates for BPD among EP infants range 10 to 89%. This study was undertaken to evaluate the incidence, mortality, and medication use associated with BPD in the US.

    Materials and Methods We undertook a population-based cohort study of liveborn EP infants identified from the electronic medical records of Kaiser Permanente Northern California between January 1997 and December 2016. Newborns with major congenital malformations were excluded. We assessed the incidence of BPD (with or without other complications of prematurity [intraventricular hemorrhage or retinopathy of prematurity), mortality rates at 2 years, and medication use up to 2 years of age. International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification (ICD-9-CM/ICD-10-CM) codes were used to identify BPD.

    Results A total of 2,154 (0.31%) infants from 704,989 live births met the study definition of EP. BPD was present in 34.3% (n = 739) of EP infants during birth hospitalization. Among infants with BPD, 52.5% were males and 75.5% were born following singleton pregnancies. The cumulative mortality rate (birth to >2 years) among EP infants with BPD (with or without other complication) was 9.2%. Among EP infants with BPD who survived to 36 weeks of postmenstrual age (PMA), the (crude) hazard ratio (HR) for mortality associated with BPD was 1.85 (95% confidence interval [CI]: 0.83–4.11), versus infants with no BPD diagnosis; after controlling for gestation age, birth weight, maternal age, and select comorbidities, the adjusted HR was 1.37 (95% CI: 0.59–3.15). Overall, 49.9% children with BPD (369/739) received medications for pulmonary comorbidities between birth and year corrected age (CA); 47.0% (316/673) and 41.5% (279/672) children received medications at 1 and 2 years corrected age, respectively. The most frequently received medications were inhaled bronchodilators, inhaled steroids, and systemic corticosteroids.

    Conclusion This retrospective database analysis showed that BPD is a common complication among EP infants. Among EP infants who survived to 36 weeks of PMA, BPD did not significantly increase the risk of mortality. Until age 2, medication use to treat respiratory complications was common.

    Conflict of Interest

    None declared.


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    Die Autoren geben an, dass kein Interessenkonflikt besteht.