RESUMO
BACKGROUND: The advances in perinatal intensive care have increased the survival rate of extremely low birthweight (ELBW) and gestational age infants. Among them the risk of developing bronchopulmonary dysplasia (BPD) remains high. AIM: To evaluate the frequency of BPD by birthweight and gestational age, to identify the main postnatal risk factors and the associated comorbidities. METHODS: 683 VLBW infants (< 1500g) were admitted in NICU from 2008 to 2010. 597 survived more than 28 days and were included in this study. BPD was diagnosed if supplemental O2 for the first 28 days was necessary; the severity was assessed by the need of O2 and/or ventilator support at 36 gestational weeks (gw). RESULTS: 27.6% (n = 164) infants were with supplemental O2 at 28d of life (BPD-group), 10.9% (n = 65) were with moderate, 3.9% (n = 23) with severe BPD (FiO2 > 30% and/or ventilator support). Infants with BPD were with significantly higher CRIB (9.9 ± 3.1) compared with those without BPD (4.0 ± 3.0), p < 0.0001. The frequency decreased progressively from almost 100% at 23gw or birthweight < 600g to single cases after 31gw and bitthweight > 1200g. Logistic regression analysis showed that each gestational week decreased the odds of BPD by 60%; each CRIB point increased the odds by 62%. Each point increment in 1/5 min Apgar-scores reduced the risk by 40%/50% respectively The need for ventilator support increased from 1.4 ± 2.7 days (no-BPD group) to 52.8 ± 5.1 days (severe-BPD infants), p < 0.05. Postnatal complications significantly increasing the odds for BPD were found to be: PDA - 19.7, Pneumothorax - 12.1 times. There was a significant correlation between BPD, severe brain injury and ROP (p < 0.000 1). CONCLUSION: The frequency of BPD strongly correlates with gestational age and birthweight and CRIB. Additional risk factors are low A pgar scores, PDA and air leak syndrome. Associated comorbidities as severe brain injury and ROP further worsen the long term prognosis.
