Interstitial Pneumonia Pattern on Day 7 Chest radiograph Predicts Bronchopulmonary Dysplasia in Preterm Infants

Abstract

Introduction: Early identification of infants at higher risk of developing bronchopulmonary dysplasia (BPD) may allow a targeted approach for reducing BPD. We aimed to evaluate the hypothesis that interstitial pneumonia pattern on day 7 chest radiograph predicts BPD or death before 36 weeks postmentrual age(PMA). Methods: We retrospectively reviewed the medical charts of 336 preterm infants whose birth weights were <1,500 g and gestational ages were <32 postmenstrual weeks. Data were collected from 304 preterm infants admitted to Seoul National University Bundang Hospital between January 2008 and December 2014. Day 7 chest radiographs were independently reviewed by two pediatric radiologists who were unaware of the clinical information on the individual infant. Results: Interstitial pneumonia pattern on day 7 chest radiograph was independently associated with BPD or death before 36 weeks PMA (odds ratio [OR] 4.03, 95% confidence interval [CI] 1.13-14.43). Interstitial pneumonia pattern on day 7 chest radiograph predicted BPD or death with 25.0% sensitivity, 97.79% specificity, 88.57% positive predictive value, and 65.79% negative predictive value. Histologic chorioamnionitis was a preceding factor that was independently associated with interstitial pneumonia pattern on day 7 chest radiograph (OR 3.73, 95% CI 1.34-10.33). Conclusions: Interstitial pneumonia pattern on day 7 chest radiograph has a high specificity for predicting BPD or death and can be utilized to select high risk preterm infants who will benefit most from preventive intervention against BPD.