377 - Early Oxygen Trajectories As Predictors Of Bronchopulmonary Dysplasia Severity In Extremely Preterm Infants

Publication Number: 1361.377

Muhammad Zaid H. Hussain, University of Texas Medical Branch School of Medicine, Houston, TX, United States; Sunil K. Jain, University of Texas Medical Branch, Galveston, TX, United States; Deepika Krishnan, University of Texas Medical Branch School of Medicine, Coppell, TX, United States; Nidhi M.. Subramanian, University of Texas Medical Branch School of Medicine, Sugar Land, TX, United States

Background: Bronchopulmonary dysplasia (BPD) remains a major morbidity among neonates born < 28 weeks gestation. Identifying early, noninvasive predictors of BPD severity can refine risk stratification and guide preventive strategies. We examined if oxygen requirements in the first three postnatal weeks can predict development and severity of BPD per Jensen criteria.

Objective: To determine whether early postnatal FiO₂ requirements at days 7, 14, and 21 of life predict the subsequent development or severity of BPD in extremely preterm infants ( < 28 weeks gestation).

Design/Methods: In this retrospective study we included infants born < 28 weeks admitted to a level IV NICU from 2016 to 2023. Infants with lethal chromosomal, congenital anomalies, died or transferred before 36 weeks were excluded. FiO₂ values at days 7, 14, and 21 were categorized as: Group 1 (≤30%), Group 2 (31-40%), and Group 3 (≥41%). BPD was defined and graded (No BPD, Grade 1, 2, 3) based on the Jensen criteria.Associations between FiO₂ groups and both BPD diagnosis and severity were first evaluated using Chi-square tests. Separate day-specific logistic regressions (adjusted for gestational age and birth weight) compared FiO₂ groups (Group 3 vs 1, 2 vs 1, 3 vs 2) for BPD (yes/no). Multinomial logistic regression were applied to model BPD grade (0-3) as the outcome.

Results: A total of 306 infants were screened, with 99 excluded, 207 neonates were included. The overall incidence of BPD was 72%. Chi-square analyses demonstrated that higher FiO₂ bands were significantly associated with both the presence and increasing severity of BPD (χ² p < 0.001 for days 14 and 21). In day-specific logistic models adjusted for gestational age and birth weight, FiO₂ ≥ 41% was associated with increased odds of BPD: Day 7 OR 2.6 (95% CI 1.2-5.8, p=0.014), Day 14 OR 3.4 (1.6-7.2, p=0.001), and Day 21 OR 5.1 (2.4-10.9, p< 0.001. Multinomial models further showed a stepwise relationship between FiO₂ and BPD grade, where Day 21 FiO₂ ≥ 41% predicted Grade 3 BPD RRR 3.7 (2.2-6.2, p=0.0037) and Day 14 ≥ 41% also predicted Grade 3 BPD RRR 2.2 (1.0-4.5, p=0.046).

Conclusion(s): Early, persistent oxygen requirements strongly predict presence and severity of BPD. FiO₂ ≥ 41% at Day 21 is a robust independent marker of severe (Grade 3) BPD, outperforming earlier days. This simple, routinely available metric could support early identification of high-risk infants for preventive or therapeutic interventions. Larger multicenter studies incorporating additional clinical variables should be done further enhance long-term predictive modeling and individualized care strategies for BPD.

Study Descriptors and Groupings


Associations Between FiO₂ Bands and BPD Outcomes
(Chi-square tests by day of life; N = 207)

Adjusted Combined Adjusted Logistic & Multinomial Regression Table
(Reference = FiO₂ ≤ 30 % [Group 1]; adjusted for GA and birth weight per 10 g; N = 207; Group 2 vs 1 comparisons were analyzed (for multinomial regression) but omitted for brevity; only Group 3 vs 1 is displayed. )