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INTRODUCTION: There is a perception that bronchopulmonary dysplasia incidence has increased in Bogotá since 2000. This study estimates its incidence, compares it with historical data and describes associated factors. MATERIALS AND METHODS: We carried out a prospective analytical cohort of preterm newborns =34 weeks of gestational age without major malformations from 12 health facilities from Bogotá in 2004. The main outcomes were incidence and severity of bronchopulmonary dysplasia, which were compared with an historical cohort (1994-1999). RESULTS: Neonatal mortality was 80/496, and the bronchopulmonary dysplasia incidence was 54.3% (95% CI, 49.4-59.1). When controlling for type of institution (low and high mortality) it appeared that being born in an institution with low mortality decreased the risk for death (OR=0.308; 95% CI, 0.129-0.736) but increased the odds for moderate-severe bronchopulmonary dysplasia (OR=1.797; 95% CI, 1.046-3.088). The risk for bronchopulmonary dysplasia was higher than for the historical control cohort (RR=1.924; 95% CI, 1.686-2.196). Weight and gestational age at birth, mechanical ventilation, intrauterine growth restriction and type of institution (low vs. intermediate-high mortality) were independently associated with bronchopulmonary dysplasia of increasing severity or even death. CONCLUSIONS: The frequency of bronchopulmonary dysplasia in Bogotá has increased markedly, and this cannot be explained solely by better survival of more fragile infants. Survivors-irrespective from gestational age-- have more frequent and more severe respiratory sequels. Probably suboptimal aggressive respiratory care practices associated with a recent transition from restricted to almost universal access to mechanical ventilation in neonatal intensive care units in Bogota might be compromising the quality of neonatal respiratory care.

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Introducción. Hay la percepción de que la frecuencia de displasia broncopulmonar en Bogotá ha aumentado notoriamente desde el año 2000. Este estudio estima su incidencia, la compara con datos históricos y describe factores asociados. Materiales y métodos. Se ensambló una cohorte analítica de 12 instituciones de Bogotá en 2004. Los participantes eran prematuros de menos de 34 semanas de edad gestacional al nacer, sin malformaciones mayores. Los desenlaces estudiados fueron la incidencia y la gravedad de la displasia broncopulmonar. Se hizo una comparación estandarizada de incidencias con cohorte histórica (1994 a 1999). Resultados. La mortalidad neonatal fue de 80/496 y la incidencia de displasia broncopulmonar, de 226/416 (54,3 %, IC 95% : 49,4-59,1). Los datos mostraron que nacer en una institución de baja mortalidad disminuía el riesgo de muerte (OR=0,308; IC 95% , 0,129-0,736), pero incrementaba el de displasia broncopulmonar moderada a grave (OR=1,797; IC 95% , 1,046-3,088). El riesgo de displasia broncopulmonar fue casi el doble del observado en la cohorte histórica (1994-1999) (RR=1,924; IC 95% 1,686 a 2,196). El incremento fue uniforme en todas las edades gestacionales. El peso y la edad gestacional al nacer, la respiración mecánica, el retardo en el crecimiento intrauterino y el tipo de institución se asociaron independientemente con el desenlace de displasia broncopulmonar grave o muerte. Conclusiones. La frecuencia de displasia broncopulmonar en Bogotá se ha incrementado por aumento en la supervivencia de niños más frágiles que si sobreviven, presentan secuelas respiratorias. Es probable que las prácticas de cuidado respiratorio agresivas y por debajo del nivel óptimo, asociadas con un reciente acceso irrestricto a la respiración mecánica en las unidades de recién nacidos en Bogotá, comprometan la calidad del cuidado respiratorio neonatal.

Introduction: There is a perception that bronchopulmonary dysplasia incidence has increased in Bogotá since 2000. This study estimates its incidence, compares it with historical data and describes associated factors. Materials and methods: We carried out a prospective analytical cohort of preterm newborns =34 weeks of gestational age without major malformations from 12 health facilities from Bogotá in 2004. The main outcomes were incidence and severity of bronchopulmonary dysplasia, which were compared with an historical cohort (1994-1999). Results: Neonatal mortality was 80/496, and the bronchopulmonary dysplasia incidence was 54.3% (95% CI, 49.4-59.1). When controlling for type of institution (low and high mortality) it appeared that being born in an institution with low mortality decreased the risk for death (OR=0.308; 95% CI, 0.129-0.736) but increased the odds for moderate-severe bronchopulmonary dysplasia (OR=1.797; 95% CI, 1.046-3.088). The risk for bronchopulmonary dysplasia was higher than for the historical control cohort (RR=1.924; 95% CI, 1.686-2.196). Weight and gestational age at birth, mechanical ventilation, intrauterine growth restriction and type of institution (low vs. intermediate-high mortality) were independently associated with bronchopulmonary dysplasia of increasing severity or even death. Conclusions: The frequency of bronchopulmonary dysplasia in Bogotá has increased markedly, and this cannot be explained solely by better survival of more fragile infants. Survivors-irrespective from gestational age­- have more frequent and more severe respiratory sequels. Probably suboptimal aggressive respiratory care practices associated with a recent transition from restricted to almost universal access to mechanical ventilation in neonatal intensive care units in Bogota might be compromising the quality of neonatal respiratory care.

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Mild maternal hypothyroidism during pregnancy can adversely affect infant development. We studied thyrotropin (TSH) levels in mothers of premature and low-birth-weight infants in Colombia, where iodized salt supplements the diet to correct iodine deficiency. The additional impact of salt restriction in mothers with hypertensive disorders was examined. Blood was spotted on filter paper from 404 mothers and their infants. Using radioimmunoassay (RIA), TSH was measured in the mothers, and TSH and thyroxine in their infants at three postpartum times. Initially, mothers had high TSH levels (i.e., TSH > 10 mU/L in half the mothers at the first assessment). Fourteen days later, only 9.3%, and at calculated term 7.5% were greater than 10 mU/L. Maternal TSH levels correlated with infant birth weight and gestational age (r = 0.47, and r = 0.49, p < 0.01). Initial TSH values were higher in salt restricted (20.1 +/- 2 mU/L, n = 76) versus control mothers (14.6 +/- 0.85, n = 328, p < 0.01), dropping dramatically in both groups 14 days later (to 3.4 +/- 0.7 mU/L vs. 2.8 +/- 0.4 mU/L) and at calculated term (2.8 +/- 0.4 mU/L vs. 2.3 +/- 0.6 mU/L). Increased maternal TSH levels during pregnancy in an iodine-deficient area may be aggravated by salt restriction. Monitoring TSH and supplementing iodine or thyroxine are recommended in pregnancy, especially if dietary salt restriction is prescribed.

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