Intercenter variability and factors associated with survival without bronchopulmonary dysplasia in extremely preterm newborns

Abstract

Background: Variability in clinical practice may influence morbidity and mortality in extremely preterm infants. We aimed to know if there are differences in survival and survival without bronchopulmonary dysplasia (BPD) in extremely preterm infants in Spanish tertiary hospitals and the potential associated factors.

Methods: Fifteen hospitals from the SEN1500 network were studied. The overall rate of survival without BPD was 61.4%. Hospitals with extreme results were grouped for comparison (Group 1; N = 2480 versus Group 2; N = 2367). A bivariate analysis of the characteristics of patients and perinatal interventions was carried out and the probability of survival without BPD was studied by Cox regression.

Results: Survival (79.0 versus 72.9%; p < .001) and survival without BPD (72.5 versus 49.1%; p < .001) were greater in Group 1. Higher gestational age, birth weight, and female sex were associated with better outcomes. Oxygen administration (aHR: 0.868 [95%CI: 0.782, 0.964]; p=.008) and intubation (aHR: 0.767 [95%CI: 0.701, 0.839]; p < .001) in delivery room were associated with lower survival without BPD. The occurrence of patent ductus arteriosus (PDA), sepsis and/or necrotizing enterocolitis (NEC) was independently associated with worse outcomes. After adjusting for confounders, the probabilities of survival without BPD were significantly higher among patients in Group 1: aHR: 1.557 [95% CI: 1.458, 1.662]; p < .001.

Conclusions: Among the studied hospitals, we found great variability in clinical practice and in the rates of survival and survival without BPD. A more conservative approach to the use of oxygen and respiratory support seems to be related to an increase in survival without BPD. Complications such as PDA, sepsis, and/or NEC decrease survival without BPD. Other variables not included in the present study could be relevant and deserve further study.

Keywords:

• Bronchopulmonary dysplasia
• extremely preterm infant
• prematurity
• respiratory distress syndrome
• survival

Acknowledgments

There was no funding for the present study. Authors thank all the investigators and coordinators of the SEN1500 Neonatal Network, presidents, vice presidents and members of the Commission SEN1500.

Hospitals and researchers from the Spanish Neonatal Network SEN1500: Complejo Hospitalario Albacete (Andrés Martínez Gutiérrez); Hospital U. de Basurto (Alberto Pérez Legorburu); Hospital Bierzo (María Teresa Prada); Hospital Cabueñes (Rafael García Mozo); Hospital Carlos Haya (Tomás Sánchez Tamayo); Hospital General Castellón (Ramón Aguilera Olmos); Hospital Central Asturias (Belén Fernández Colomer); Hospital Clínic Barcelona (Josep Figuera Aloy); Hospital Clínico San Carlos (Araceli Corredera Sánchez); hospital cruces (Amaya Rodríguez serna); hospital U. Donostia (M. Ángel Cortajarena Altuna); Hospital Elche (Josep Mut Buigues); Hospital General de Cataluña (Laura Castells Vilella); Hospital G. de Granollers (Israel Anquela Sanz); Hospital Germans Trias I Pujol (W. Coroleu); Hospital Getafe (Lucía Cabanillas Vilaplana); Hospital Infanta Margarita (José María Barcía Ruiz); Hospital Jerez (Dolores Esquivel Mora); Hospital Juan Ramón Jiménez (José Ángel Morilla Sánchez); Hospital Juan XXIII (Mar Albújar); Hospital León (Emilio Álvaro Iglesias); Hospital Miguel Servet (Segundo Rite Gracia);

Corporació Parc Taulí (Juan Badia); Hospital San Juan de Deu (Martín Iriondo Sanz); Hospital San Pedro de Logroño (Inés Esteban Díez); Hospital San Pedro de Alcántara (M^a. Jesús López Cuesta); Hospital de la Santa Creu I Sant Pau (Gemma Ginovart Galiana); Hospital Severo Ochoa (María José Santos Muñoz); Hospital Txagorritxu (María Mercedes Martínez Ayucar); Hospital Universitario Arnau de Vilanova (Eduard Solé Mir); Hospital Valme (Antonio Gutiérrez Benjumea); Hospital Virgen de la Concha (Víctor Marugán Isabel); Hospital U. Virgen de la Macarena (Mercedes Granero Asencio); Hospital Virgen de la Salud (Alicia de Ureta Huertas); Hospital U. Virgen de las Nieves (M^a Fernanda Moreno Galdó); Hospital Xeral Vigo (María Suárez Albo); Hospital Universitario de Valencia (Javier Estañ Capell); Hospital Universitario de Zaragoza (Purificación Ventura Faci); Hospital Universitario Santiago (M^a. Luz Couce Pico); Hospital General de Burgos (Cristina de Frutos Martínez); Hospital General Universitario Alicante (Miriam Salvador Iglesias); Hospital Universitario de Fuenlabrada (Laura Domingo Comeche); Hospital Universitario Gregorio Marañón (Amparo Rodríguez Herreras); Hospital Universitario La Paz (M^a. Dolores Elorza); Hospital Materno Infantil de Canarias (Lourdes Urquía Martí); Hospital Universitario Canarias (Pedro A. Fuster Jorge); Hospital Universitario de San Cecilio (Eduardo Narbona); Hospital Universitari I Politecnic La Fe (Isabel Izquierdo Macián); Hospital Universitario Reina Sofía (Juana María Guzmán Cabañas); Hospital Universitario Río Hortera (M^a. Mar Montejo Vicente); Hospital Universitario Salamanca (Pilar García González); Hospital Universitario Virgen del Rocío (Carmen Macías Díaz); Hospital Universitario Dexeus (Roser Porta); Scias-Hospital Barcelona (Silvia Martínez-Nadal).Hospital Josep Trueta (Alberto Trujillo); Complejo Hospitalario Universitario de Pontevedra (Javier Vilas González); Hospital Universitario de Ciudad Real (Miguel Ángel Cabezas); Hospital Puerta del Mar (Antonio Segado Arenas); Hospital Doce de Octubre (Carmen R. Pallás Alonso).

Disclosure statement

No potential conflict of interest was reported by the authors.