361 - MRI Parenchymal Score as a Predictor of Long-term Respiratory Support in Infants with BPD

Publication Number: 361.5734

Chawisa Janjindamai, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Nara S. Higano, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Laura Bellew, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Erik Hysinger, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jason Woods, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Paul S. Kingma, Cincinnati Children's Hospital, Cincinnati, OH, United States

Background: Bronchopulmonary dysplasia (BPD) is the most common respiratory morbidity in preterm infants. Current severity-classification systems, such as the NICHD and Jensen criteria, may not provide detailed predictions for long-term outcomes beyond 2 years of age. Our institution has developed a magnetic resonance imaging (MRI) parenchymal scoring system to evaluate structural lung abnormalities in BPD. This MRI score correlates with short-term respiratory outcomes within the first 150 days of life and can predict tracheostomy need or mortality at NICU discharge. However, its ability to predict long-term respiratory outcomes is unknown.

Objective: We hypothesized that the MRI BPD lung parenchymal score will correlate with the duration of long-term respiratory support in infants with BPD.

Design/Methods: We conducted a retrospective review of neonates who underwent ultrashort echo time pulmonary MRI at 41 +/- 8 weeks postmenstrual age, reviewing their records until they were no longer on any respiratory support. MRIs were scored by one or two trained readers. We analyzed the correlation between MRI parenchymal scores and the duration on various respiratory support, including invasive mechanical ventilation (IMV), non-invasive positive pressure ventilation (NIPPV), and nasal cannula using linear regression models.

Results: Of the 120 neonates, 113 survived until they no longer required respiratory support. The average gestational age (GA) at birth was 26 4/7 weeks (SD = 3 3/7), with an average birth weight (BW) of 1019 g (SD = 601). Forty-four percent were small for gestational age (SGA), 36% had patent ductus arteriosus (PDA) requiring medical or surgical intervention, and 44% had pulmonary hypertension (PHTN). Univariate linear regression demonstrated that MRI score, GA, BW, histories of PDA, and PHTN were significantly associated with the duration of long-term respiratory support. After adjusting for GA, SGA status, and histories of PDA and PHTN, MRI score remained significantly correlated with the duration of IMV, NIPPV, and any respiratory support. Each 1-point increase in the MRI score predicted an additional 42.9 days on IMV (p < 0.002), 40.3 days on PPV (p < 0.002), and 39.6 days on any respiratory support (p < 0.002).

Conclusion(s): The MRI parenchymal score at near term-corrected age, assessing parenchymal disease, is a promising predictor of long-term respiratory support duration in infants with BPD. This scoring tool holds significant potential for clinical use, helping physicians provide families with more accurate expectations regarding respiratory support duration.

Correlation of MRI Parenchymal Score with Duration on Invasive Mechanical Ventilation in Infants with BPD.
This scatter plot illustrates the correlation between MRI parenchymal scores and the duration of invasive mechanical ventilation (IMV). Each data point represents the average duration on IMV for infants within a specific MRI parenchymal score, with error bars showing variability in IMV duration. A positive correlation is observed with an R² value of 0.7272.

Correlation of MRI Parenchymal Score with Duration on Any Respiratory Support in Infants with BPD.
This scatter plot shows the correlation between MRI parenchymal scores and the total number of days infants required any form of respiratory support. Each point represents the average duration on any form of respiratory support, with error bars indicating variability in the duration of respiratory support within each MRI score. A positive correlation is observed with an R² value of 0.6258.