Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Predictors of death or bronchopulmonary dysplasia in preterm infants with respiratory failure

Journal of Perinatology volume 28, pages 420–426 (2008)Cite this article

Abstract

Objectives:

To identify the variables that predict death/physiologic bronchopulmonary dysplasia (BPD) in preterm infants with severe respiratory failure.

Study Design:

The study was a secondary analysis of data from the NICHD Neonatal Research Network trial of inhaled nitric oxide (iNO) in preterm infants. Stepwise logistic regression models and Classification and Regression Tree (CART) models were developed for the outcome of death or physiologic BPD (O2 at 36 weeks post-menstrual age).

Result:

Death and/or BPD was associated with lower birth weight, higher oxygen requirement, male gender, additional surfactant doses, higher oxygenation index and outborn status, but not the magnitude of response in PaO2 to iNO. The positive predictive value of the CART model was 82% at 95% sensitivity.

Conclusions:

The major factors associated with death/BPD were an increased severity of respiratory failure, lower birth weight, male gender and outborn status, but not the magnitude of initial response to iNO.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Van Meurs KP, Wright LL, Ehrenkranz RA, Lemons JA, Ball MB, Poole WK et al. Inhaled nitric oxide for premature infants with severe respiratory failure. N Engl J Med 2005; 353: 13–22.

    Article  CAS  Google Scholar 

  2. Schreiber MD, Gin-Mestan K, Marks JD, Huo D, Lee G, Srisuparp P . Inhaled nitric oxide in premature infants with the respiratory distress syndrome. N Engl J Med 2003; 349: 2099–2107.

    Article  CAS  Google Scholar 

  3. Kinsella JP, Cutter GR, Walsh WF, Gerstmann DR, Bose CL, Hart C et al. Early inhaled nitric oxide therapy in premature newborns with respiratory failure. N Engl J Med 2006; 355: 354–364.

    Article  CAS  Google Scholar 

  4. Ballard RA, Truog WE, Cnaan A, Martin RJ, Ballard PL, Merrill JD et al. Inhaled nitric oxide in preterm infants undergoing mechanical ventilation. N Engl J Med 2006; 355: 343–353.

    Article  CAS  Google Scholar 

  5. Dimitriou G, Greenough A, Kavvadia V, Devane SP, Rennie JM . Outcome predictors in nitric oxide treated preterm infants. Eur J Pediatr 1999; 158: 589–591.

    Article  CAS  Google Scholar 

  6. Walsh MC, Yao Q, Gettner P, Hale E, Collins M, Hensman A et al. Impact of a physiologic definition on bronchopulmonary dysplasia rates. Pediatrics 2004; 114: 1305–1311.

    Article  Google Scholar 

  7. Sinkin RA, Cox C, Phelps DL . Predicting risk for bronchopulmonary dysplasia: selection criteria for clinical trials. Pediatrics 1990; 86: 728–736.

    CAS  PubMed  Google Scholar 

  8. Ryan SW, Nycyk J, Shaw BN . Prediction of chronic neonatal lung disease on day 4 of life. Eur J Pediatr 1996; 155: 668–671.

    Article  CAS  Google Scholar 

  9. Yoder BA, Anwar MU, Clark RH . Early prediction of neonatal chronic lung disease: a comparison of three scoring methods. Pediatr Pulmonol 1999; 27: 388–394.

    Article  CAS  Google Scholar 

  10. Ambalavanan N, Carlo WA, Shankaran S, Bann CM, Emrich SL, Higgins RD et al. Predicting outcome of neonates diagnosed with hypoxemic-ischemic encephalopathy. Pediatrics 2006; 118: 2084–2093.

    Article  Google Scholar 

  11. Germanson TP, Lanzino G, Kongable GL, Torner JC, Kassell NF . Risk classification after aneurysmal subarachnoid hemorrhage. Surg Neurol 1998; 49: 155–163.

    Article  CAS  Google Scholar 

  12. Werneck GL, de Carvalho DM, Barroso DE, Cook EF, Walker AM . Classification trees and logistic regression applied to prognostic studies: a comparison using meningococcal disease as an example. J Trop Pediatr 1999; 45: 248–251.

    Article  CAS  Google Scholar 

  13. Subhedar NV, Tan AT, Sweeney EM, Shaw NJ . A comparison of indices of respiratory failure in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 2000; 83: F97–F100.

    Article  CAS  Google Scholar 

  14. Tyson JE, Younes N, Verter J, Wright LL . Viability, morbidity, and resource use among newborns of 501- to 800-g birth weight. National Institute of Child Health and Human Development Neonatal Research Network. JAMA 1996; 276: 1645–1651.

    Article  CAS  Google Scholar 

  15. Kumar D, Super DM, Fajardo RA, Stork EE, Moore JJ, Saker FA . Predicting outcome in neonatal hypoxic respiratory failure with the score for neonatal acute physiology (SNAP) and highest oxygen index (OI) in the first 24 h of admission. J Perinatol 2004; 24: 376–381.

    Article  Google Scholar 

  16. Trachsel D, McCrindle BW, Nakagawa S, Bohn D . Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure. Am J Respir Crit Care Med 2005; 15: 206–211.

    Article  Google Scholar 

  17. Thome UH, Carlo WA, Pohlandt F . Ventilation strategies and outcome in randomised trials of high frequency ventilation. Arch Dis Child Fetal Neonatal Ed 2005; 90: F466–F473.

    Article  CAS  Google Scholar 

  18. Henderson-Smart DJ, Cools F, Bhuta T, Offringa M . Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database of Syst Rev 2007; (3): CD000104. doi: 10.1002/14651858.CD000104.pub2.

  19. Keszler M, Donn SM, Bucciarelli RL, Alverson DC, Hart M, Lunyong V et al. Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema. J Pediatr 1991; 119: 85–93.

    Article  CAS  Google Scholar 

  20. Joshi VH, Bhuta T . Rescue high frequency jet ventilation versus conventional ventilation for severe pulmonary dysfunction in preterm infants. The Cochrane Database of Syst Rev 2006; 25 (1): CD000437. doi: 10.1002/14651858.CD000437.pub2.

    Article  Google Scholar 

Download references

Acknowledgements

This research was supported by grants from the National Institute of Child Health and Human Development (U10 HD34216, U10 HD27853, U10 HD27871, U10 HD40461, U10 HD40689, U10 HD27856, U10 HD27904, U10 HD40498, U10 HD40521, U01 HD36790, U10 HD21385, U10 HD27880, U10 HD27851 and U10 HD 21373) and from the General Clinical Research Centers Program (M01 RR08084, M01 RR06022, M01 RR00750, M01 RR00070, M01 RR00039 and M01 RR00044). INO Therapeutics provided study gas and support to centers that were not part of the NICHD Neonatal Research Network.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    N Ambalavanan & W A Carlo

  2. Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA

    K P Van Meurs & D K Stevenson

  3. RTI International, Research Triangle Park, NC, USA

    R Perritt & W K Poole

  4. Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA

    R A Ehrenkranz

  5. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    J A Lemons

  6. National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD, USA

    R D Higgins

Authors
  1. N Ambalavanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K P Van Meurs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R Perritt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W A Carlo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R A Ehrenkranz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D K Stevenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J A Lemons
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. W K Poole
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R D Higgins
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the NICHD Neonatal Research Network, Bethesda, MD

Corresponding author

Correspondence to N Ambalavanan.

Appendix

Appendix

The following investigators participated in the Preemie Inhaled Nitric Oxide Study: Brown University Women & Infant's Hospital—William Oh MD, Angelita Hensman BSN RNC, Daniel Gingras RRT; Emory University—Barbara J. Stoll MD, Lucky Jain MD, Ellen Hale RN BS, Irma Seabrook BS RRT-NPS; Indiana University Riley Hospital for Children and Methodist Hospital—Greg Sokol MD, Dianne Lorant MD, Diana Dawn Appel RN BSN, Lucy Miller RN BSN, Dale Chriscinske BS RRT NPS, Jeff Attwood RRT; Northwestern University—Robin Steinhorn MD, Michael Sautel RRT; Stanford University Lucile Salter Packard Children's Hospital—Krisa Van Meurs MD, Bethany Ball BS CCRC, Dan Proud RCP; University of Alabama at Birmingham University Hospital-UAB—Waldemar A. Carlo MD, Shirley S. Cosby RN BSN, Robert B. Johnson RRT; University of Cincinnati University Hospital, Cincinnati Children's Hospital Medical Center and Good Samaritan—Jon Fridriksson MD, Barb Warner MD, Marcia Mersmann RN, Barb Alexander RN, Jody Shively RN, Holly Mincey RN, Mary Hoover RRT, Sharon Sapienz RRT, Eric Stephenson RRT; University of California-San Diego UCSD Medical Center and Sharp Mary Birch Hospital for Women—Neil N Finer MD, Maynard R Rasmussen MD, Chris Henderson CRTT, Clarence Demetrio RN, Wade Rich RRT-NPS, Christine Joseph, RRT-NPS; University of Florida Wolfson Children's Hospital at Baptist Medical Center and Shands Jacksonville Medical Center—Mark Hudak MD, Shannon Osbeck RN BSN, Elizabeth Case RN BSN CCRC, Amanda Kellum RRT, Lamont Hogans RRT; University of Rochester Golisano Children's Hospital at Strong—Carl T D'Angio MD, Linda Reubens RN, Greg Hutton RRT; University of Texas—Dallas Parkland—Abbot Laptook MD; Susie Madison RN, Gay Hensley RN, Nancy Miller RN, Glenn Metoyer RRT; University of Texas—Houston Memorial Hermann Children's Hospital—Kathleen Kennedy MD MPH, Georgia McDavid RN, Danny Emerson RRT RCP; Medical College of Wisconsin—Ganesh Konduri MD, Mike Paquette RCP/CRT, Steven Wong RCP/CRT; Wake Forest University Wake Forest University Baptist Medical Center, Forsyth Medical Center and Brenner Children's Hospital—Judy Aschner MD, T Michael O'Shea MD MPH, Nancy Peters RN, BJ Hansell RRT CCRC, Jennifer Griffin RRT RCP, Clay Adams RRT RCP; Wayne State University Hutzel Women's Hospital & Children's Hospital of Michigan—Seetha Shankaran MD, Rebecca Bara RN BSN, Geraldine Muran RN BSN, Wonder Weekfall RRT; Yale University New Haven Children's Hospital Richard A Ehrenkranz MD, Patricia Gettner RN, Art Caldwell AS RRT.

The members of the National Institute of Child Health and Human Development Neonatal Research Steering Committee were: Brown University—William Oh MD, Case Western University—Avroy A Fanaroff MD, Duke University—Ronald N Goldberg MD, Emory University—Barbara J Stoll MD, Indiana University—James A Lemons MD, Stanford University—David K Stevenson MD, University of Alabama at Birmingham—Waldemar A Carlo MD, University of Cincinnati—Edward F Donovan MD, University of California-San Diego—Neil N Finer MD, University of Miami—Shahnaz Duara MD, University of Rochester—Dale L Phelps MD, University of Texas- Dallas—Abbot R Laptook MD, University of Texas—Houston—Jon E Tyson MD MPH, Wake Forest University—T Michael O'Shea MD MPH, Wayne State University—Seetha Shankaran MD, Yale University—Richard A Ehrenkranz MD, University of Cincinnati—Alan Jobe MD (Chair).

The members of the Data Coordinating Center (RTI International) were: W Kenneth Poole PhD, Betty Hastings, Carolyn Petrie MS.

The members of National Institute of Child Health and Human Development were: Rosemary D Higgins MD, Linda L Wright MD, Elizabeth McClure MEd.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ambalavanan, N., Van Meurs, K., Perritt, R. et al. Predictors of death or bronchopulmonary dysplasia in preterm infants with respiratory failure. J Perinatol 28, 420–426 (2008). https://doi.org/10.1038/jp.2008.18

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2008.18

Keywords

This article is cited by

Search

Advanced search

Quick links