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Prediction of chronic oxygen dependency

Presented at the Neonatal Society 2005 Summer Meeting (programme).

May C, Kavvadia V, Dimitriou G, Greenough A

Division of Asthma, Allergy and Lung Biology, King’s College London, London, UK

Background: Chronic oxygen dependency (COD), bronchopulmonary dysplasia, is a common and important adverse outcome of very premature birth. Affected patients frequently require readmission to hospital and suffer troublesome respiratory symptoms requiring treatment throughout the preschool years. It is therefore essential that safe and effective preventative strategies are identified. Key to optimum use of such strategies is the development of an accurate and simple predictor of high risk infants.

Objective: To determine whether a simplified pulmonary score is able to predict COD.

Methods: Many “predictive” scores exist, but are complex. As a consequence an existing pulmonary score (1) was simplified such that the score was calculated from the FiO2 multiplied by the level of respiratory support (ventilation 2.5; CPAP 1.5; nasal cannula oxygen 1.0). Infants were scored on days 2 and 7.

Patients: 168 VLBW infants entered into a randomised fluid trial (2). The study was approved by the Research Ethics Committee of King’s College Hospital and parents gave informed written consent.

Results: Infants who were oxygen dependent at 28 days had higher scores on days 2 (p=0.0007) and day 7 (p<0.0001) than the non-oxygen dependent infants. Similarly the day 2 (p<0.0001) and day 7 (p<0.0001) scores of the infants who had COD at 36 weeks postmenstrual age were higher than the non-COD infants. Construction of ROC curves demonstrated an area under the curve of 0.851 for the score on day 7 in predicting COD.

Conclusion: This simplified pulmonary sore may be useful in identifying infants at high risk for developing chronic oxygen dependency.

1. Madan, A., et al., A pulmonary score for assessing the severity of neonatal chronic lung disease. Pediatrics, 2005. 115(4): p. e450-7.
2. Kavvadia, V., et al., Randomised trial of fluid restriction in ventilated very low birthweight infants. Arch Dis Child Fetal Neonatal Ed, 2000. 83(2): p. F91-6.

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