Oxygenation index in the first 21 days of life is a predictor for bronchopulmonary dysplasia grade in very preterm infants

Abstract

Abstract Background BPD grades are associated with long-term respiratory and neurodevelopmental outcomes. Identification of additional early-life predictors is in need to improve the performance of their early prediction. The objective of the study was to assess the association of the oxygenation index (OI) trajectory in the first three weeks of life with BPD grades. Methods A single-center retrospective study was performed. Generalized additive mixed modeling was used to model OI trajectories for each BPD grade subgroup. A multinomial regression model was then developed to quantify the relationship between OI dynamics and the odds of BPD grades. Results 254 infants were identified for inclusion in the trajectory modeling, including 242 infants with sufficient OI data for multinomial regression analysis. A total of 6,243 OI data points were available for modeling. Average OI change was − 0.33 ± 0.52 (n = 85) in the No-BPD group, -0.04 ± 0.75 (n = 82) in the Low-Grade BPD group, and 0.22 ± 0.65 (n = 75) in the High-Grade BPD group. OI modeling showed distinct trajectory patterns for the No-BPD, Low-Grade, and High-Grade BPD subgroups. A multinomial regression analysis showed that the initial OI value and the average OI daily change in the first 3 weeks of life both independently correlated with BPD grade outcomes after adjusting for birth gestation, birth weight z-score, and sex. Conclusion Early-life OI trajectory is a useful marker for BPD grade prediction. Prospective studies are needed to further validate the findings. Alternatives to OI, such as respiratory severity score or oxygen saturation index, also merit further studies to improve clinical usability.