Prediction of outcome of preterm infants with severe bronchopulmonary dysplasia

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Abstract
Forty‐four preterm infants of less than 30 weeks gestation and birthweight £ 1250 g, with severe bronchopulmonary dysplasia requiring mechanical ventilation for at least 28 days, were reviewed. Twenty‐seven infants (61%) survived; 17 died. There were no significant differences between survivors and non‐survivors with respect to birthweight, gestational age, sex, Apgar score at 5 min or pulmonary diagnosis. Non‐survivors displayed more severe changes on chest X‐ray than the survivors. Peak inspiratory pressure (PIP), ventilator rate (VR), ventilator index and mean airways pressure were significantly higher in the non‐surviving infants on days 2, 3, 4, 7, 14, 21 and 28, with non‐survivors also having significantly higher alveolar‐arterial oxygen gradients and lower arterial‐alveolar oxygen ratios than the survivors. Discriminant analysis with cross‐validation by pairing PIP and VR on day 28 produced a positive predictive value for non‐survival of 88% and a negative predictive value of 89%. This result was better than was obtained for any other pair of ventilator parameter or oxygenation index. Discriminant analysis by combining X‐ray appearances with ventilator settings did not improve the prediction. Having established a statistical model based on the PIP and VR of ventilator‐dependent preterm infants on day 28, the outcome can be predicted with a high degree of confidence. This has the immediate potential application of indicating to staff in the neonatal unit a realistic approach to take when counselling parents of these infants.