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:

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

Journal of Perinatology volume 26, pages 197–200 (2006)Cite this article

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.

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

Similar content being viewed by others

References

  1. Caldwell EJ, Powell RD, Mullooly JP . Interstitial emphysema: a study of physiological factors involved in experimental induction of the lesion. Am Rev Res Dis 1970; 102: 516.

    CAS  Google Scholar 

  2. Kraybill EN, Rynyan DK, Bose CL, Khan JH . Risk factors for chronic lung disease in infants with birth weight of 751–1000 gms. J Pediatr 1989; 155: 115.

    Article  Google Scholar 

  3. Verma R . Respiratory distress syndrome of the newborn infant. Obstet Gynecol Rev 1995; 50(7): 542–555.

    CAS  Google Scholar 

  4. Gurakan B, Tarkan A, Arda IS, Coskun M . Persistent pulmonary interstitial emphysema in an unventilated neonate. Pediatr Pulmonol 2002; 34(5): 409–411.

    Article  Google Scholar 

  5. Papile LA, Burnstein J, Burnstein R, Koffler H . Incidence and evolution of the subependymal and intraventricular hemorrhage: a study of infants with birth weight less than 1500 gms. J Pediatr 1978; 92: 524–529.

    Article  Google Scholar 

  6. Gyetvai K, Hannah M, Hodnett D, Ohlsson A . Tocolysis for preterm labor: a systematic review. Obstet Gynecol 1999; 94(5): 869–877.

    Article  CAS  Google Scholar 

  7. Norwitz ER, Robinson JN, Challis JRG . Current concepts: the control of labor. N Engl J Med 1999; 341: 660–666.

    Article  CAS  Google Scholar 

  8. Scudiero R, Khoshnood B, Pryde P, Lee K-S, Wall S, Mittendorf R . Perinatal death and tocolytic magnesium sulphate. Obstet Gynecol 2000; 96(2): 178–182.

    CAS  PubMed  Google Scholar 

  9. Mittendorf R, Covert R, Boman J, Khosneed B, Lee K-S, Seigler M . Is tocolytic magnesium sulphate associated with increased total pediatric mortality. Lancet 1997; 350: 1517–1518.

    Article  CAS  Google Scholar 

  10. Mittendorf R, Dambrosia J, Pryde PG, Lee K-S, Ganopoulos JG, Bessinger RE et al. Magnesium sulfate in preterm labor did not prevent adverse infant outcomes and increased infant mortality. Ev Based Obstet Gynecol 2003; 5(2): 62–63.

    Article  Google Scholar 

  11. Mittendorf R, Dambrosia J, Pryde PG, Lee K-S, Gianopoulos JG, Besinger RE et al. Association between the use of antenatal magnesium sulphate in preterm labor and adverse health outcomes in the infants. Am J Obstet Gynaecol 2002; 186(6): 1111–1118.

    Article  CAS  Google Scholar 

  12. Landau R, Scott JA, Smiley RM . Magnesium induced vasodilatation in the dorsal hand vein. BJOG 2004; 111(5): 446–451.

    Article  Google Scholar 

  13. Weintraub Z, Solovenchik M, Reichman B, Ritachild A, Waiseman D, Davkin O et al. Effects of maternal tocolysis on the incidence of severe periventricular/intraventricular hemorrhage in very low birth weight infants. Arch Dis Child Fet Neo Ed 2001; 85(1): F13–F17.

    Article  CAS  Google Scholar 

  14. Malaeb SN, Rassi AI, Haddod MC, Seoud MA, Younis KA . Bone mineralization in newborns whose mothers received magnesium sulfate for tocolysis of premature labor. Paedeatr Rad 2004; 34(5): 384–386.

    Article  Google Scholar 

  15. Rantonen T, Kaapa P, Jalonen J, Elkblad U, Peltola O, Valimaki I et al. Antenatal magnesium sulfate exposure is associated with prolonged parathyroid hormone suppression in preterm neonates. Acta Paedeatr 2001; 90(3): 278–281.

    Article  CAS  Google Scholar 

  16. Crowther CA, Hiller JE, Doyle LW, Halam RR . Effects of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial. JAMA 2003; 290: 2669–2678.

    Article  CAS  Google Scholar 

  17. Elimian A, Verma R, Ogburn P, Weincek V, Spitzer A, Quirk JG . Magnesium sulfate and neonatal outcomes of preterm neonates. J Mat-fetal Neo Med 2002; 12: 118–122.

    CAS  Google Scholar 

  18. Farkouh LJ, Thorp JA, Jones PG, Clark RH, Knox GE . Antenatal magnesium exposure and neonatal demise. Am J Obstet Gynecol 2001; 185: 869–872.

    Article  CAS  Google Scholar 

  19. Canterino JC, Verma UL, Visintainer PF, Figueroa R, Klein SA, Tejani NA . Maternal magnesium sulfate and the development of neonatal periventrivular leucomalacia and intraventricular hemorrhage. Obstet Gynecol 1999; 93(2): 396–402.

    CAS  PubMed  Google Scholar 

  20. Kimberlin DF, Hauth JC, Goldenburgh RL, Bottoms SF, Iams JD, Mercere B et al. The effects of maternal magnesium sulfate treatment on neonatal morbidity in &lt;or=1000 gms infants. Am J Perinatol 1998; 15(11): 635–641.

    Article  CAS  Google Scholar 

  21. Grether JK, Hoogstrate J, Selvin S, Nelson KB . Magnesium Sulfate tocolysis and risk of neonatal death. Am J Obstet Gynecol 1998; 178(1 Part 1): 1–6.

    Article  CAS  Google Scholar 

  22. Mezad D, Hallak M, Huleihel M, Gortzak-Uzan L, Smolin A, Mazor M . Intravenous magnesium sulfate effects on maternal serum and amniotic fluid cytokines levels in preterm labor patients. Magnes Res 2002; 15(3–4): 247–252.

    CAS  PubMed  Google Scholar 

  23. Crowther CA . Magnesium sulfate for preventing preterm birth in threatened preterm labor. Cochrane Database Syst Rev 2002; (4): CD001060.

  24. Azria E . Magnesium sulfate in obstetrics: current data. J Gynecol Obstet Biol Reprod (Paris) 2004; 33(6 Part 1): 510–517.

    Article  CAS  Google Scholar 

  25. Mittendorf R, Pryde PG . An overview of the possible relationship between antenatal pharmacological magnesium and cerebral palsy. J Perinat Med 2000; 28: 286–293.

    Article  CAS  Google Scholar 

  26. Hirtz DG, Nelson K . Magnesium sulfate and cerebral palsy in premature infants. Cur Opin Pediatr 1998; 10: 131–137.

    Article  CAS  Google Scholar 

  27. Volpe JP . Neurology of the Newborn, 4th edn. WB Saunders Co: Philadelphia, 2001, pp 429–493.

    Google Scholar 

  28. Leviton A, Paneth N, Susser M, Reuss L, Allred EN, Kuban K et al. Maternal receipt of magnesium sulfate does not seem to reduce the risk of neonatal white matter damage. Pediatr 1997; 99: 1–5.

    Article  Google Scholar 

Download references

Acknowledgements

This research was supported by General Clinical Research Grant number 5-MO1-RR-10710.

Author information

Authors and Affiliations

  1. Department of Pediatrics, SUNY School of Medicine, Stony Brook, NY, USA

    R P Verma

  2. Case Western Reserve University, Cleveland, OH, USA

    S Chandra

  3. Neonatology Fellow, Cook County Hospital, Chicago, IL, USA

    R Niwas

  4. Department of Preventive Medicine, General Clinical Research Center, SUNY School of Medicine, Stony Brook, NY, USA

    E Komaroff

Authors
  1. R P Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Chandra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R Niwas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E Komaroff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R P Verma.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Verma, R., Chandra, S., Niwas, R. et al. Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants. J Perinatol 26, 197–200 (2006). https://doi.org/10.1038/sj.jp.7211456

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211456

Keywords

This article is cited by

Search

Advanced search

Quick links