New Insights on Early Patterns of Respiratory Disease among Extremely Low Gestational Age Newborns

Stefano Nobile, Paolo Marchionni, Giovanni Vento, Valentina Vendettuoli, Claudio Marabini, Alessandra Lio, Cinzia Ricci, Domenica Mercadante, Mariarosa Colnaghi, Fabio Mosca, Costantino Romagnoli, Virgilio Carnielli

Research output: Contribution to journalArticlepeer-review


Background: The analysis of early patterns of lung disease among preterm infants may help to identify predictors of pulmonary deterioration. Objectives: To analyze FIO2 requirement in the first 14 days of life among preterm infants and to find predictors of bronchopulmonary dysplasia (BPD). Methods: Retrospective cohort study. Setting: 3 Italian level III NICUs. Population: Infants born between 240/7 and 276/7 weeks' gestational age (GA) who survived to 14 days. A consecutive sample of 588 infants was analyzed. Daily mode FIO2 in the first 2 weeks of life were analyzed according to the criteria defined by Laughon et al. [Pediatrics 2009;123:1124-1131], who found 3 early respiratory patterns: Consistently low FIO2 (LowFIO2), pulmonary deterioration (PD), and early persistent pulmonary deterioration (EPPD). Factors associated with pulmonary deterioration were studied by univariate and multivariate analysis. Results: Forty percent of infants had low FIO2, 18% had pulmonary deterioation, 21% had early persistent pulmonary deterioration, and 21% had a previously unreported pattern (pulmonary improvement, PI). The prevalence of BPD was 7% in the LowFIO2 group, 28% in the PI group, 44% in the PD group, and 62% in the EPPD group (p = 0.000). Infants with lung deterioration were more frequently males (OR = 2.019, CI: 1.319-3.090, p = 0.001), had lower GA (OR = 0.945, CI: 0.915-0.975, p = 0.000), higher incidence of severe respiratory distress syndrome (OR = 2.956, CI: 1.430-6.112, p = 0.003), and lack of postnatal caffeine (OR = 0.167, CI: 0.052-0.541, p = 0.003). Conclusions: We report 4 distinct patterns of early respiratory disease associated with significantly different prevalence of BPD and discuss risk factors for lung deterioration.

Original languageEnglish
Pages (from-to)53-59
Number of pages7
Issue number1
Publication statusPublished - Jun 1 2017


  • Chronic lung disease
  • Early respiratory disease
  • Preterm infants

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental Biology


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