Factors associated with recurrent wheezing in the first year of life among premature newborns from Neonatal Intensive Care Units

Ramos, Andréia Caroline Ribeiro; Castro, Patrícia Soares; Souza, Rafael Gomes; Carneiro, Jair Almeida; Pinho, Lucineia de; Caldeira, Antônio Prates

doi:10.1590/1806-93042021000300010

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ORIGINAL ARTICLES • Rev. Bras. Saúde Mater. Infant. 21 (03) • Jul-Sep 2021 • https://doi.org/10.1590/1806-93042021000300010 copy

Factors associated with recurrent wheezing in the first year of life among premature newborns from Neonatal Intensive Care Units

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to determine the prevalence and factors associated with recurrent wheezing in the first year of life among premature newborns from Neonatal Intensive Care Units, in the city of Montes Claros, northern Minas Gerais.

Methods:

cross-sectional study, with data collection from medical records of a follow-up clinic, interviews with mothers and, eventually, search in hospital records. Bivariate analyzes were carried out between sociodemographic and clinical characteristics and recurrent wheezing. Variables associated up to the level of 20% were analyzed by binary logistic regression, and associations defined by the Odds Ratio and respective 95% confidence intervals. Only variables associated with a 5% significance level were maintained in the final model of logistic regression.

Results:

among 277 infants studied, about one fifth (21.3%) were extremely low birth weight preterm and more than half (60.7%) had birth weight below 1500 grams. The prevalence of recurrent wheezing was 14.4% (CI95% = 10.3-18.4). Mechanical ventilation (OR = 2.12; CI95% = 1.09-4.76; p = 0.030) and oxygen therapy time ≥ 15 days (OR = 2.49; CI95%= 1.12-5.00; p = 0.010) were the risk factors for the event.

Conclusions:

there is a high prevalence of recurrent wheezing in the evaluated group and the associated variables reiterate the risk of prolonged oxygen therapy and mechanical ventilation for premature newborns.

Key words
Infant; Premature; Respiratory sounds; Prevalence; Risk factors

Variables	N	%
Maternal parity
Primiparous	127	42.2
Multiparous Pregnancy complications	150	57.8
Hypertension	99	35.7
Diabetes	13	4.7
Infections	29	10.5
None referred	112	40.4
Others Prenatal corticosteroid therapy	24	8.7
Yes	142	51.3
No Time of rupture of membranes (hours)	135	48.7
> 18	67	24.2
≤ 18 Childbirth delivery	210	75.8
Natural	88	31.8
Cesarean surgery Sex	189	68.2
Male	150	54.2
Female Gestational age (weeks)	127	45.8
< 28	31	11.2
28-32	169	61.0
> 32 Apgar 5th min	77	27.8
≥ 7	194	70.0
< 7 Birth weight (g)	83	30.0
< 1,000	59	21.3
1,000 - 1,499	109	39.4
≥ 1,500 Newborn classification^* * AGA= Appropriate for gestational age; SGA= Small for gestational age; LGA= Large for gestational age.	109	39.4
AGA	182	65.7
SGA	85	30.7
LGA	10	3.6

Variables	N	%
Oxygen therapy time (days)
< 7	63	22.7
7 - 14	30	10.8
15-29	124	44.8
> 30	60	21.7
Use of vasoactive amines
No	190	68.6
Yes	87	31.4
Sepsis
No	112	40.4
Yes	165	59.6
Blood transfusion
No	182	65.7
Yes	95	34.3
Neurological complications
No	226	81.6
Yes	51	18.4

Variables	Recurrent wheezing				p	OR gross (CI95%)
	Yes		No
	n	%	n	%
Sex					0.252
Female	15	11.8	112	88.2		0.67 (0.34 - 1.33)
Male	25	16.7	125	83.3		1.0
Maternal parity					0.067
Primiparous	13	10.2	114	89.8		0.52 (0.26-1.06)
Multiparous	27	18.0	123	82.0		1.0
Prenatal corticosteroid therapy					0.607
No	21	15.6	114	84.8		1.19 (0.61-2.33)
Yes	19	13.4	123	86.6		1.0
Time of rupture of membranes (hours)					0.788
> 18	9	13.4	58	86.6		0.89 (0.40- 1.99)
≤ 18	31	14.8	179	85.2		1.0
Childbirth delivery					0.227
Cesarean surgery	24	12.7	165	87.3		1.23 (0.77 - 3.05)
Natural	16	18.2	72	81.8		1.0
Apgar 5th min					0.137
< 7	8	9.6	75	90.4		0.54 (0.24- 1.22)
≥ 7	32	16.5	162	93.5
Resuscitation at birth					0.507
Yes	21	15.9	111	84.1		1.25 (0.64-2.46)
No	19	13.1	126	86.9
Oxygen therapy time (days)					0.019
≥ 15	33	19.9	151	82.1		2.68 (1.14-6.33)
< 15	7	7.5	86	92.5		1.0
Mechanical ventilation support					0.022
Yes	30	18.5	132	81.5		2.39 (1.12-5.10)
No	10	8.7	105	91.3		1.0
Birth weight (g))					0.259
< 1,000	12	20.3	47	79.7		1.48 (0.65-3.39)
1,000g - 1,499	12	11.0	97	89.0		0.72 (0.32-1.60)
≥ 1,500	16	14.7	93	85.3		1.0
Gestational age (weeks)					0.048
< 28	9	29.0	22	71.0		3.09 (1.09-8.76)
28-32	22	13.0	147	87.0		1.13 (0.49-2.59)
> 32	9	11.7	68	88.3		1.0
Use of vasoactive amines					0.102
Yes	17	19.5	70	80.5		1.76 (0.89-3.50)
No	23	12.1	167	87.9		1.0
Blood transfusion					0.024
Yes	20	21.1	75	78.9		2.16 (1.10-4.25)
No	20	11.0	162	89.0		1.0
Sepsis					0.449
Yes	26	15.8	139	84.2		1.31 (0.65-2.64)
No	14	12.5	98	87.5		1.0

Variables	p	OR adjusted (CI95%)
Maternal parity	0.079
Primiparous		0.47 (0.20-1.09)
Multiparous		1.0
Apgar 5th min	0.067
< 7 ≥ 7		0.45 (0.19- 1.17)
Oxygen therapy time (days)	0.010
≥ 15		2.49 (1.12-5.00)
< 15		1.0
Mechanical ventilation support	0.030
Sim		2.12 (1.09-4.76)
No		1.0
Gestational age (weeks)	0.138
< 28		1.96 (0.81-4.75)
28-32		1.02 (0.88-2.20)
> 32		1.0
Use of vasoactive amines	0.463
Yes		1.32 (0.59-2.97)
No		1.0
Blood transfusion	0.231
Yes		1.66 (0.72-3.80)
No		1.0

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[1] Authors' contribution

Caldeira AP, Pinho L, Carneiro JA: idea conception, data analysis, project management, original manuscript draft, and final writing review. Ramos ACR, Souza RG: data collection, data analysis, and final draft review. All authors approved the final version of the article.