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Oxygen needs during resuscitation and surfactant to achieve stabilisation were independent risks factors for pulmonary interstitial emphysema in preterm infants
Author(s) -
NuñezRamiro Antonio,
Aguar Marta,
Cernada Maria,
ParraLlorca Anna,
Vento Maximo
Publication year - 2018
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14048
Subject(s) - medicine , gestational age , mean airway pressure , resuscitation , continuous positive airway pressure , interstitial lung disease , univariate analysis , mechanical ventilation , anesthesia , oxygen therapy , peak inspiratory pressure , gestation , lung , surgery , pediatrics , multivariate analysis , respiratory system , pregnancy , tidal volume , genetics , obstructive sleep apnea , biology
Aim Pulmonary interstitial emphysema is a severe complication of mechanical ventilation in preterm infants that leads to air leakage and, or, chronic lung disease. We determined the associated risk factors. Methods This was a retrospective case–control study from 2005 to 2014 at a regional referral centre in Valencia, Spain. The cases were 54 preterm infants up to 30 weeks’ gestation and, or, born weighing less than 1500 g, who were diagnosed with pulmonary interstitial emphysema ( PIE ). The 54 controls were preterm infants without PIE matched by gestational age. Univariate analysis and multivariate analysis were performed to assess the independent predicting factors. Results Infants with PIE had been resuscitated with higher mean fractional inspired oxygen concentration (FiO 2 ) (p = 0.008), had received higher peak mean positive end expiratory pressure (p = 0.00) and higher mean airway pressure (p = 0.026) 24 hours before diagnosis. PIE patients also received more surfactant (p = 0.00) and had higher mortality (p = 0.034). A Cox regression model identified that independent risk factors were the total amount of surfactant administered and the mean FiO 2 during the 24 hours before diagnosis. Conclusion Independent risk factors for pulmonary interstitial emphysema in preterm infants were higher oxygen during resuscitation and a higher need for surfactant and ventilatory pressures before diagnosis.