Cardiorespiratory monitoring can predict outcomes in premature infants

In extremely preterm newborns, physiologic data are independently related with a poor respiratory prognosis, says an article published in American Journal of Respiratory and Critical Care Medicine.

In extremely preterm newborns, immature respiratory control is linked with apnea, periodic breathing, intermittent hypoxemia (IH), and bradycardia. However, it is unclear whether such occurrences indicate a poorer respiratory prognosis on their own. As a result, Namasivayam Ambalavanan and colleagues undertook this study to see if an analysis of cardiorespiratory monitoring data may predict unfavorable respiratory outcomes at 40 weeks (w) PMA, as well as other outcomes such bronchopulmonary dysplasia (BPD) at 36 weeks (w) PMA.

The Prematurity-Related Ventilatory Control (Pre-Vent) project was a multicenter prospective cohort study that included children born at 29 weeks gestation who were monitored continuously for cardiorespiratory function. The primary outcome might be "favorable" (alive and previously released, or inpatient and off respiratory medications/O2/support at 40w PMA) or "unfavorable" (dead or inpatient/previously released on respiratory medications/O2/support at 40w PMA).

The key findings of this study were:

1. There were 717 newborns assessed (median birth weight 850g; gestation 26.4w), with 53.7% having a favorable result and 46.3% having an unfavorable outcome.

2. The physiologic data indicated an unfavorable outcome, with accuracy increasing with age (AUC 0.79 at Day 7, 0.85 at Day 28, and 32w PMA).

3. The best predictive physiologic characteristic was intermittent hypoxemia with SpO290% (IH90).

4. Models based only on clinical data or integrating physiologic and clinical data also performed well, with AUCs ranging from 0.84-0.85 at Day 7 and 14, to 0.86-0.88 at Day 28 and 32w PMA.

5. At 40w PMA, intermittent hypoxemia with SpO280% (IH80) was the most important physiologic predictor of severe BPD and mortality or mechanical ventilation.

Prematurity-Related Ventilatory Control (Pre-Vent) data from cardiorespiratory monitoring may give predictive information regarding the clinical outcomes of extremely preterm newborns.

Reference:

Ambalavanan, N., Weese-Mayer, D. E., Hibbs, A. M., Claure, N., Carroll, J. L., Moorman, J. R., Bancalari, E., Hamvas, A., Indic, P., Kemp, J. S., Ratcliffe, S. J., Troendle, J. F., & Lake, D. E. (2023). Cardiorespiratory Monitoring Data to Predict Respiratory Outcomes in Extremely Preterm Infants. In American Journal of Respiratory and Critical Care Medicine. American Thoracic Society. https://doi.org/10.1164/rccm.202210-1971oc