BRONCHOPULMONARY DYSPLASIA IN VERY-LOW-BIRTH-WEIGHT INFANTS

The incidence, clinical presentation and severity of bronchopulmonary dysplasia (BPD) in 110 consecutive very low birthweight (VLBW) infants admitted to the National University Hospital Neonatal Intensive Care Unit between October 1985 and January 1989 is reviewed. Thirty-two infants died, giving an overall survival rate of 70.9%. Sixty infants (54.4%) required mechanical ventilation in the first week of life; 24 (40%) of these infants died. Of the 36 survivors, 23 required oxygenation at 28 days of life and 21 fulfilled the criteria for BPD (35% of the 60 ventilated and 58% of the survivors). The incidence of BPD in all VLBW infants is 19% and of VLBW survivors 27%. Birthweight and gestational age appear to be important determinants. All the survivors in the 501-750 g birthweight group developed BPD compared to 6.25% in those above 1250 g. None of those > 30 weeks gestation developed BPD. Two forms of BPD were observed; the 'severe' group presented radiologically with chest radiographs characteristic of Stage IV BPD, while the 'mild' group with small or normal sized lungs demonstrated irregular strands of radio-densities alternating with areas of normal or increased lucency. The duration of mechanical ventilation and oxygen dependency were significantly longer in the 'severe' group, with the mean maximum peak inspiratory pressure, mean airway pressure, and Fio2 required in the first week of life being also significantly higher. Hyaline membrane disease was the main cause of respiratory failure requiring ventilation. The other causes were persistent pulmonary hypertension (1) and apnoea of prematurity (3); all of the latter developed only mild BPD. Those who developed BPD required a significantly longer period of hospitalization, a longer period to regain their birthweight and attain a weight of 2 kg, and a higher incidence of retinopathy of prematurity compared with those without BPD even after correcting for the earlier gestational age of the BPD group.