Infants born at <29 weeks: pulmonary outcomes from a hybrid perinatal system.

WE Truog, MF Nyp, J Taylor, LL Gratny, H Escobar, WM Manimtim, CI Lachica, A Khmour, OO Oluola, AA Oshodi, M Norberg, H Daiand EK PallottoOBJECTIVE: To assess pulmonary outcomes of infants o29 weeks gestational age (GA), delivered at level I, II and III facilities, toidentify potentially modifiable factors affecting bronchopulmonary dysplasia (BPD) severity and to assess the external generalizabilityof the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) BPD Outcome Estimator.STUDY DESIGN: Outcomes for infants o29 weeks GA born during (2008–2010) and delivered either at an inborn level III center orin a level II or III metropolitan area hospital with transfer to a level IV center, or delivered in a distant level I or II center and thentransported to a level IV center were assessed. BPD severity was compared with the NICHD Neonatal BPD Outcome Estimator.RESULT: Of 158 infants who comprised the cohort, 28 (17.8%) had no BPD, 39 (24.2%) had mild BPD, 45 (28.7%) had moderate BPD,31 (19.7%) had severe BPD and 15 (9.6%) died at p36 weeks post menstrual age. Site of birth did not predict severe BPD or death.Receiver operator characteristic curves showed fair predictability for none/mild and severe BPD.CONCLUSION: BPD severity was not dependent on site of birth. The NICHD BPD outcome estimator provides fair prediction forextreme outcomes.Journal of Perinatology (2014) 34, 59–63; doi:10.1038/jp.2013.125; published online 17 October 2013Keywords: bronchopulmonary dysplasia; prematurity; pulmonary outcomesINTRODUCTIONHospitals with variable resources for perinatal resuscitation andstabilization of very preterm infants continue to deliver extremelypreterm infants o29 weeks gestation. In all, 74.7% of infantso1500g birthweight were delivered in hospitals with high-levelintensive care units.