{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:45:08Z","timestamp":1789447508175,"version":"build-2803163510"},"reference-count":44,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1999,12,1]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To identify risk factors for chronic lung disease (CLD) in a population-based cohort of very low birth weight infants, born in an era of surfactant usage. We specifically investigated the effects of antenatal steroids, nosocomial infection, patent ductus arteriosus (PDA), fluid management, and ventilator support strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Data were prospectively collected on 1244 infants born in North Carolina in 1994 with birth weights 500 to 1500 g, and treated at 1 of the 13 intensive care nurseries across the state. The outcome of interest was CLD, defined as dependency on supplemental oxygen at 36 weeks' postmenstrual age. Multivariate odds ratios (OR) and 95% confidence intervals (CI) were estimated with logistic regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Among 865 survivors to 36 weeks' postmenstrual age, 224 (26%) had CLD. Nosocomial infection (OR: 2.0; 95% CI: 1.4\u20133.3), fluid intake on day 2 (OR: 1.06 per 10 mL increase; 95% CI: 1.01\u20131.11), and the need for ventilation at 48 hours of life (OR: 2.2; 95% CI: 1.3\u20133.7) were associated with an increased risk of CLD. Among infants ventilated at 48 hours, nosocomial infection (OR: 1.64; 95% CI: 1.02\u20132.62) and PDA (OR: 1.9; 95% CI: 1.2\u20133.1) were associated with an increased risk. No association was found with antenatal steroid receipt or increased levels of ventilator support.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>This analysis suggests that with widespread use of surfactant, nosocomial infection, PDA, and water balance persist as risk factors for CLD.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.104.6.1345","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:45:45Z","timestamp":1092440745000},"page":"1345-1350","source":"Crossref","is-referenced-by-count":212,"title":["Risk Factors for Chronic Lung Disease in the Surfactant Era: A North Carolina Population-based Study of Very Low Birth Weight Infants"],"prefix":"10.1542","volume":"104","author":[{"given":"Diane D.","family":"Marshall","sequence":"first","affiliation":[{"name":"From the Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton","family":"Kotelchuck","sequence":"additional","affiliation":[{"name":"Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E.","family":"Young","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics and"},{"name":"Department of Pediatrics, Wake Area Health Education Center, Raleigh, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl L.","family":"Bose","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauree","family":"Kruyer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wake Area Health Education Center, Raleigh, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Michael","family":"O'Shea","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Raleigh North Carolina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the North Carolina Neonatologists Association","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[1999,12,1]]},"reference":[{"key":"2021121003100932100_B1","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/S0022-3476(95)70362-4","article-title":"Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease.","volume":"126","author":"Rojas","year":"1995","journal-title":"J Pediatr"},{"key":"2021121003100932100_B2","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1542\/peds.79.1.26","article-title":"Is chronic lung disease in low birth weight infants preventable? A survey of eight centers.","volume":"79","author":"Avery","year":"1987","journal-title":"Pediatrics"},{"key":"2021121003100932100_B3","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1542\/peds.82.4.554","article-title":"Variability in 28-day outcomes for very low birth weight infants: an analysis of 11 neonatal intensive care units.","volume":"82","author":"Horbar","year":"1988","journal-title":"Pediatrics"},{"key":"2021121003100932100_B4","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1542\/peds.90.5.663","article-title":"Improved survival accounts for most, but not all, of the increase in bronchopulmonary dysplasia.","volume":"90","author":"Parker","year":"1992","journal-title":"Pediatrics"},{"key":"2021121003100932100_B5","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/S0022-3476(05)80746-2","article-title":"Multivariate assessment of traditional risk factors for chronic lung disease in very low birth weight neonates.","volume":"119","author":"Palta","year":"1991","journal-title":"J Pediatr"},{"key":"2021121003100932100_B6","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/S0022-3476(05)81968-7","article-title":"Rate of bronchopulmonary dysplasia as a function of neonatal intensive care practices.","volume":"120","author":"Van Marter","year":"1992","journal-title":"J Pediatr"},{"key":"2021121003100932100_B7","first-page":"327","article-title":"Chronic lung disease of prematurity in the state of Wisconsin.","volume":"9","author":"Kayata","year":"1989","journal-title":"J Perinatol"},{"key":"2021121003100932100_B8","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1055\/s-2007-999632","article-title":"Survival and ventilatory course of a regional cohort of very low birthweight (501\u20131500 gm) infants.","volume":"6","author":"Powers","year":"1989","journal-title":"Am J Perinatol"},{"key":"2021121003100932100_B9","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/archpedi.1987.04460070086031","article-title":"Chronic lung disease in infants with very low birth weight.","volume":"141","author":"Kraybill","year":"1987","journal-title":"Am J Dis Child"},{"key":"2021121003100932100_B10"},{"key":"2021121003100932100_B11","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1542\/peds.98.5.931","article-title":"Outcomes of extremely low birth weight infants.","volume":"98","author":"Hack","year":"1996","journal-title":"Pediatrics"},{"key":"2021121003100932100_B12","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1016\/S0002-9378(98)70037-7","article-title":"Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994.","volume":"179","author":"Stevenson","year":"1998","journal-title":"Am J Obstet Gynecol"},{"key":"2021121003100932100_B13","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1542\/peds.82.4.527","article-title":"Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period.","volume":"82","author":"Shennan","year":"1988","journal-title":"Pediatrics"},{"key":"2021121003100932100_B14","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1001\/archpedi.1985.02140060033022","article-title":"Bronchopulmonary dysplasia and pulmonary insufficiency of prematurity: lack of correlation of outcome with gas exchange abnormalities at 1 month of age.","volume":"139","author":"Truog","year":"1985","journal-title":"Am J Dis Child"},{"key":"2021121003100932100_B15","first-page":"375","article-title":"Association between severity of chronic lung disease and first-year outcomes of very low birthweight infants.","volume":"17","author":"deRegnier","year":"1997","journal-title":"J Perinatol"},{"key":"2021121003100932100_B16"},{"key":"2021121003100932100_B17","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/0002-9378(95)90222-8","article-title":"Antenatal corticosteroid therapy: a meta-analysis of the randomized trial, 1972 to 1994.","volume":"173","author":"Crowley","year":"1995","journal-title":"Am J Obstet Gynecol"},{"key":"2021121003100932100_B18","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1542\/peds.92.2.191","article-title":"Decreasing mortality associated with the introduction of surfactant therapy: an observational study of neonates weighing 601 to 1300 grams at birth.","volume":"92","author":"Horbar","year":"1993","journal-title":"Pediatrics"},{"key":"2021121003100932100_B19","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1056\/NEJM199405263302102","article-title":"Effect of surfactant on morbidity, mortality, and resource use in newborn infants weighing 500 to 1500 grams.","volume":"330","author":"Schwartz","year":"1994","journal-title":"N Engl J Med"},{"key":"2021121003100932100_B20","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1542\/peds.102.6.1333","article-title":"Annual summary of vital statistics, 1997.","volume":"102","author":"Guyer","year":"1998","journal-title":"Pediatrics"},{"key":"2021121003100932100_B21","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1542\/peds.101.4.642","article-title":"Trends in mortality and cerebral palsy in a geographically based cohort of very low birth weight neonates born 1982 to 1994.","volume":"101","author":"O'Shea","year":"1998","journal-title":"Pediatrics"},{"key":"2021121003100932100_B22","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/j.1440-1754.1997.tb01629.x","article-title":"Chronic oxygen dependency in infants born at 24\u201332 weeks gestation: the role of antenatal and neonatal factors.","volume":"33","author":"Todd","year":"1997","journal-title":"J Paediatr Child Health"},{"key":"2021121003100932100_B23","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/00006454-199807000-00004","article-title":"Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants.","volume":"17","author":"Fanaroff","year":"1998","journal-title":"Pediatr Infect Dis J"},{"key":"2021121003100932100_B24","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1016\/S0022-3476(05)80658-4","article-title":"Hydration during the first days of life and the risk of bronchopulmonary dysplasia in low birth weight infants.","volume":"116","author":"Van Marter","year":"1990","journal-title":"J Pediatr"},{"key":"2021121003100932100_B25","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S0022-3476(89)80345-2","article-title":"Risk factors for chronic lung disease in infants with birth weights of 751 to 1000 grams.","volume":"115","author":"Kraybill","year":"1989","journal-title":"J Pediatr"},{"key":"2021121003100932100_B26","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/S0022-3476(05)82491-6","article-title":"Relative likelihood of bronchopulmonary dysplasia based on pulmonary mechanics measured in preterm neonates during the first week of life.","volume":"120","author":"Bhutani","year":"1992","journal-title":"J Pediatr"},{"key":"2021121003100932100_B27","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1001\/archpedi.1995.02170190027005","article-title":"Hypocarbia before surfactant therapy appears to increase bronchopulmonary dysplasia risk in infants with respiratory distress syndrome.","volume":"149","author":"Garland","year":"1995","journal-title":"Arch Pediatr Adolesc Med"},{"key":"2021121003100932100_B28","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1542\/peds.86.3.331","article-title":"Maternal glucocorticoid therapy and reduced risk of bronchopulmonary dysplasia.","volume":"86","author":"Van Marter","year":"1990","journal-title":"Pediatrics"},{"key":"2021121003100932100_B29","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0022-3476(05)82056-6","article-title":"New Ballard Score, expanded to include extremely premature infants.","volume":"119","author":"Ballard","year":"1991","journal-title":"J Pediatr"},{"key":"2021121003100932100_B30","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1136\/bmj.314.7094.1624","article-title":"Neonatal risk factors for cerebral palsy in very preterm babies: time oriented analyses of risk are useful.","volume":"314","author":"Allred","year":"1997","journal-title":"Br Med J"},{"key":"2021121003100932100_B31","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/S0022-3476(77)80628-8","article-title":"Lung mechanics in congenital heart disease with increased and decreased pulmonary blood flow.","volume":"90","author":"Bancalari","year":"1977","journal-title":"J Pediatr"},{"key":"2021121003100932100_B32","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/S0022-3476(78)80382-5","article-title":"Bronchopulmonary dysplasia: possible relationship to pulmonary edema.","volume":"92","author":"Brown","year":"1978","journal-title":"J Pediatr"},{"key":"2021121003100932100_B33","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/S0022-3476(81)80728-7","article-title":"Maximum diuresis\u2014a factor in predicting recovery from respiratory distress syndrome and the development of bronchopulmonary dysplasia.","volume":"98","author":"Spitzer","year":"1981","journal-title":"J Pediatr"},{"key":"2021121003100932100_B34","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/S0022-3476(79)80442-4","article-title":"Bronchopulmonary dysplasia: clinical presentation.","volume":"95","author":"Bancalari","year":"1979","journal-title":"J Pediatr"},{"key":"2021121003100932100_B35","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/S0095-5108(18)30444-5","article-title":"The contribution of experimental models to our understanding of the pathogenesis and treatment of bronchopulmonary dysplasia.","volume":"19","author":"DeLemos","year":"1992","journal-title":"Clin Perinatol"},{"key":"2021121003100932100_B36","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1111\/j.1651-2227.1992.tb12205.x","article-title":"Fluid restriction for preventing bronchopulmonary dysplasia? Reduced fluid intake during the first weeks of life improves the outcome of low-birth-weight infants.","volume":"81","author":"Tammela","year":"1992","journal-title":"Acta Paediatr"},{"key":"2021121003100932100_B37","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1203\/00006450-198910000-00013","article-title":"Persistent elastase\/proteinase inhibitor imbalance during prolonged ventilation of infants with bronchopulmonary dysplasia: evidence for the role of nosocomial infection.","volume":"26","author":"Walti","year":"1989","journal-title":"Pediatr Res"},{"key":"2021121003100932100_B38","first-page":"31","article-title":"Lung lavage of newborns with respiratory distress syndrome: prolonged neutrophil influx is associated with bronchopulmonary dysplasia.","volume":"83","author":"Ogden","year":"1983","journal-title":"Chest"},{"key":"2021121003100932100_B39","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1203\/00006450-199408000-00017","article-title":"Increased activity of interleukin-6 but not tumor necrosis factor-\u03b1 in lung lavage of premature infants is associated with the development of bronchopulmonary dysplasia.","volume":"36","author":"Bagghi","year":"1994","journal-title":"Pediatr Res"},{"key":"2021121003100932100_B40","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/S0140-6736(88)92536-6","article-title":"Association of Ureaplasma urealyticum infection of the lower respiratory tract with chronic lung disease and death in very low birth weight infants.","volume":"2","author":"Cassell","year":"1988","journal-title":"Lancet"},{"key":"2021121003100932100_B41","first-page":"542","article-title":"Ureaplasma urealyticum colonization and chronic lung disease in low birth weight infants.","volume":"7","author":"Sanchez","year":"1988","journal-title":"Pediatr Infect Dis J"},{"key":"2021121003100932100_B42","first-page":"547","article-title":"The role of Ureaplasma urealyticum and other pathogens in the development of chronic lung disease of prematurity.","volume":"7","author":"Wang","year":"1988","journal-title":"Pediatr Infect Dis J"},{"key":"2021121003100932100_B43","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S0022-3476(81)80604-X","article-title":"Prospective clinical comparison of two methods for mechanical ventilation of neonates: rapid rate and short inspiratory time versus slow rates and long inspiratory time.","volume":"98","author":"Heicher","year":"1981","journal-title":"J Pediatr"},{"key":"2021121003100932100_B44","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/S0022-3476(83)80254-6","article-title":"Factors associated with pulmonary airleak in premature infants receiving mechanical ventilation.","volume":"102","author":"Primhak","year":"1983","journal-title":"J Pediatr"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/104\/6\/1345\/887822\/pe129901345p.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/104\/6\/1345\/887822\/pe129901345p.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T07:32:54Z","timestamp":1734507174000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/104\/6\/1345\/62713\/Risk-Factors-for-Chronic-Lung-Disease-in-the"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,12,1]]},"references-count":44,"journal-issue":{"issue":"6","published-online":{"date-parts":[[1999,12,1]]},"published-print":{"date-parts":[[1999,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.104.6.1345","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[1999,12,1]]}}}