332 - Occurrence of severe cardiorespiratory events in extremely preterm infants: a longitudinal study

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 332
Publication Number: 332.345

Jill Ranger, McGill University, Montreal, PQ, Canada; Ana Clouâtre, McGill University Faculty of Medicine and Health Sciences, Montréal, PQ, Canada; Stephanie Craciunas, Universite de Montreal Faculty of Medicine, Montreal, PQ, Canada; Wissam Shalish, Division of Neonatology, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada, Montreal, PQ, Canada

Presenting Author(s)

Jill Ranger, MDCM, PhD (she/her/hers)

Pediatric Resident
McGill University
Montreal, Quebec, Canada

Background:

In extremely preterm infants (gestational age [GA] ≤ 28 weeks), episodes of apneas, bradycardias, and desaturations (known as “cardiorespiratory events” [CREs]) are common, frequently require intervention, and are associated with increased morbidities. As contemporary practices have shifted towards earlier use of non-invasive respiratory support in increasingly more immature infants, the patterns of CRE occurrence in this population are unknown.

Objective:

To longitudinally describe the occurrence of severe CREs as a function of time and respiratory support in extremely preterm infants.

Design/Methods:

This was a single-center retrospective study of infants with GA ≤ 28 weeks admitted to the NICU (Jan 2016 to Dec 2020). The daily number of severe CREs (requiring tactile stimulation, oxygen supplementation, or bag-mask ventilation) and type of respiratory support during each CRE (invasive vs. non-invasive vs. none) were recorded from birth until 34 weeks postmenstrual age. Descriptive statistics were used to evaluate the weekly number of severe CREs for all infants, per GA, and per type of respiratory support. Two-way ANOVA was used to assess the effects of postnatal week and respiratory support on the frequency of severe CREs.

Results: A total of 233 infants (125 females, 108 males) were included in the study, with median GA 26 [24.68 - 27] weeks and median birthweight 810 [680 - 962] grams (Table). Overall, the average number of severe CREs was 15 ± 16 events/week in the first week of life, peaked at 3 weeks (17 ± 14 events/week), and then decreased with increasing postnatal age. Interestingly, the timing of the peak number of severe CREs (18-20 events/week) was inversely correlated with GA as follows: GA 27wks – postnatal week 1, GA 26wks – postnatal week 2, GA 25wks – postnatal week 3, GA 24wks – postnatal week 6 (Figure 1). The proportion of infants primarily on non-invasive respiratory support was 49% in the first week of life and increased to 66% and 74% by postnatal weeks 4 and 8, respectively (Figure 2). Across all postnatal weeks, severe CREs occurred significantly more frequently on non-invasive compared to invasive respiratory support [F(1)=209.7, p< 0.001], with a significant interaction between postnatal week and respiratory support [F(7)=6.5, p< 0.001].

Conclusion(s):

In a contemporary cohort of extremely preterm infants, patterns of severe CREs varied over time and across GAs, with the highest occurrence while on non-invasive respiratory support. Strategies to reduce the burden of CREs, especially during the early postnatal period while on non-invasive respiratory support, are needed.