Original Article

Journal of Perinatology (2006) 26, 197–200. doi:10.1038/sj.jp.7211456

Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants

R P Verma1, S Chandra2, R Niwas3 and E Komaroff4

  1. 1Department of Pediatrics, SUNY School of Medicine, Stony Brook, NY, USA
  2. 2Case Western Reserve University, Cleveland, OH, USA
  3. 3Neonatology Fellow, Cook County Hospital, Chicago, IL, USA
  4. 4Department of Preventive Medicine, General Clinical Research Center, SUNY School of Medicine, Stony Brook, NY, USA

Correspondence: Dr RP Verma, Department of Pediatrics, Division of Neonatology, HSC T 11-060, SUNY School of Medicine at Stony Brook, NY 11794-8111, USA. E-mail: Rita.Verma@sunysb.edu

Received 9 September 2005; Revised 15 December 2005; Accepted 19 December 2005.

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Abstract

Objective:

 

We studied the ante- and postnatal risk factors and clinical outcomes associated with pulmonary interstitial emphysema (PIE) in extremely low birth weight infants (ELBW, <1000 g at birth) in the present era of tocolytics, antenatal steroid and postnatal surfactant administration.

Study design:

 

This was a retrospective case-controlled study of all ELBW admitted consecutively during a designated study-period in a level III nursery. Data were analyzed by performing univariate and multivariate analysis as applicable.

Results:

 

Infants with PIE had lower 1 and 5 min Apgar scores (P=0.04 and 0.003 respectively), increased surfactant utilization (P=0.004), higher maximum inspired oxygen concentration (P=0.04) and mean airway pressure administration (P=0.02) during the first week of life, and increased neonatal mortality (P=0.01). They received higher antenatal doses of magnesium sulfate (MgSO4) (P=0.02). 56% of infants with PIE were exposed to more than 10 g of MgSO4 (Mg10), compared to 15% in non-PIE group (P=0.01). The multivariate logistic regression analysis including significant co-variates revealed an independent association between Mg10 and PIE (P=0.01, Odds ratio 19.8, 95% CI 1.5–263).

Conclusion:

 

Pulmonary interstitial emphysema is associated with increased mortality in ELBW infants. Mg10 is an independent risk factor for PIE in this population.

Keywords:

PIE, MgSO4 tocolysis, neonatal death

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