474 - Pathological and/or radiological findings at 28 days of life in bronchopulmonary dysplasia are associated with neurodevelopmental outcomes at three years in very low birth weight infants.

Publication Number: 4465.474

Yuki Ashida, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan; Shin Kato, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan; Shota Kawasaki, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan; Masanori Kouwaki, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan

Background: Bronchopulmonary dysplasia (BPD) deteriorates long-term respiratory outcomes in very low birth weight infants (VLBWIs) and imposes a substantial developmental and economic burden. In Japan, BPD is diagnosed at 28 days of life and classified with histological chorioamnionitis (hCAM) and a bubbly/cystic (BC) appearance on chest radiographs. Both have been associated with adverse respiratory outcomes; however, their relationship with long-term neurodevelopmental outcomes remains unclear.

Objective: To examine whether early pathological and radiological factors (hCAM and BC), are independently associated with neurodevelopmental outcomes at three years in VLBWIs.

Design/Methods: We retrospectively reviewed VLBWIs admitted to the NICU of the Japanese Red Cross Nagoya Daini Hospital between April 2010 and March 2018. Infants with chromosomal abnormalities or congenital syndromes, those who died before discharge, or were lost to follow-up were excluded. The dependencies of developmental quotient (DQ) at three years on hCAM and BC appearance were examined using multivariable linear regression analysis.

Results: Among 333 infants, 253 were eligible for analysis. In univariable analyses, gestational age (GA), birth weight (BW), 5-min Apgar score < 5, hCAM, admission temperature, hemodynamically significant patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH), and sepsis were significantly associated with DQ at three years (all p< 0.05). In multivariable analysis adjusted for GA, sex, 5-min Apgar score < 5, antenatal corticosteroid exposure, and IVH, hCAM was associated with lower DQ (B = -9.1; 95% CI -15.8 to -2.3; p = 0.009), whereas BC was associated with higher DQ (B = 14.4; 95% CI 2.1 to 26.7; p = 0.02) and home oxygen therapy (B = 0.33; 95% CI 0.19 to 0.47; p< 0.001). A post hoc analysis limited to extremely low birth weight infants showed similar trends: hCAM remained associated with lower DQ (B = -9.4; 95% CI -17.6 to -1.1; p = 0.026), and BC with higher DQ (B = 24.8; 95% CI 7.4 to 42.1; p = 0.006) and home oxygen therapy (B = 0.30; 95% CI 0.05 to 0.56; p = 0.019).

Conclusion(s): hCAM was significantly associated with poorer neurodevelopmental outcomes at three years. In contrast, BC was associated with better outcomes, although this finding should be interpreted cautiously due to the limited sample size. Early identification of at-risk infants using hCAM and BC at 28 days of life may help guide early risk stratification and follow-up to support better outcomes. Further multicenter studies with adequate sample sizes are warranted to validate these findings.

Figure 1. Flow Diagram of Study Selection
VLBWIs：very low birth weight infants　CLD：chronic lung disease

Table 1. Patient Characteristics
Comparison of neonatal characteristics with and without CLD
CLD：chronic lung disease　CAM：chorioamnionitis　PDA：Patent Ductus Arteriosus　IVH：Intraventricular Hemorrhage

Table 2. Multivariable linear regression analysis
Multivariable aanalysis adjusted for gestational age, sex, 5-min Apgar score <5, antenatal corticosteroid exposure, and Intraventricular Hemorrhage
DQ：developmental quotient　CAM：chorioamnionitis