Bronchopulmonary Dysplasia Precursors Influence Risk of White Matter Injury and Adverse Neurodevelopmental Outcome in Preterm Infants

BACKGROUND: Cumulative supplemental oxygen (CSO) and cumulative mean airway pressure (CMAP) are associated with bronchopulmonary dysplasia (BPD) in preterm infants, but their relationships to white matter injury (WMI) and neurodevelopment have not been evaluated. METHODS: Preterm infants <32 weeks gestation were prospectively imaged with 3T-MRI near term. CSO and CMAP were retrospectively summed over the first 14 and 28 days. Neurodevelopment was assessed at 30-months adjusted using the Bayley-III. ROC and linear regression were used to evaluate the relationship between CSO, CMAP, and BPD with WMI and neurodevelopmental performance, respectively. RESULTS: Of 87 infants, 30 (34.5%) had moderate-to-severe BPD, which was associated with WMI (OR 5.5, 95% CI 1.1–34.9, p=0.012). CSO and CMAP predicted WMI as well as BPD (AUC 0.68–0.77). CSO was independently associated with decreased language and cognitive performance (mean difference at 14d: −11.0, 95% CI −19.8 to −2.2, p=0.015; −9.8, 95% CI −18.9 to −0.7, p=0.035, respectively) at 30-months adjusted. CONCLUSIONS: BPD precursors predict WMI as well as BPD. Cumulative supplemental oxygen over the first 14 days of life is independently associated with lower language and cognitive performances. These data suggest that early respiratory status influences the risk of adverse neurodevelopment in preterm infants.