Pérez Pérez G, Navarro Merino M, Romero Pérez Ma M, Sáenz Reguera C, Pons Tubío A, Polo Padillo J
Secciones de Neumología Infantil, Hospital Universitario Virgen Macarena, Seville, Spain.
An Pediatr (Barc). 2004 Feb;60(2):117-24. doi: 10.1016/s1695-4033(04)78231-4.
Bronchopulmonary dysplasia (BPD) is the most frequent cause of respiratory morbidity in the first 2 years of life among preterm infants who survive the first 28 days.
To evaluate respiratory morbidity in the first 2 years of life in a group of preterm infants born at (32 weeks' gestation with BPD (oxygen requirement at 36 weeks' postconceptional age) by comparing it with that in preterm infants born at (32 weeks without BPD and with a control group of full term infants without neonatal morbidity. To determine whether respiratory morbidity in children with BPD decreases after the age of 2 years.
Group I: preterm children with BPD (n = 29). Group II: preterm children without BPD (n = 29). Group III: children with appropriate gestational age and weight (n = 32). A cross-sectional, descriptive study of the three groups was performed over a 2-year period. In 17 children in group 1, the study was prolonged to the age of 4 years. We analyzed wheezing on at least two occasions, use of inhaled bronchodilators, use of inhaled glucocorticosteroids for more than 6 months, and hospitalization for respiratory illness. The chi-square test and Fischer's exact test were performed.
At least one episode of wheezing occurred in 25 children (86.2%) in group I compared with 12 children (41.4%) in group II and 6 (18.8%) in group III. Nineteen children (65.5%) in group I and none in the remaining two groups received treatment with inhaled glucocorticosteroids for more than 6 months (p < 0.001). Inhaled bronchodilators were used by 25 children (86.2%) in group I compared with 12 (41.4%) in group II and 6 (18.8%) in the control group (p < 0.001). Twelve children (41.3%) in group I were hospitalized for respiratory illness compared with 8 (27.6%) in group II. There were no admissions among the control group. None of the children with BPD who received prophylaxis with palivizumab contracted respiratory syncytial virus infection. Seventeen children with BPD were evaluated until the age of 4 years. Episodes of wheezing decreased from 88.2% in the first year to 41 % between the third and fourth years (p < 0.001). Treatment with inhaled glucocorticosteroids for more than 6 months was given to 88.2% in the first year, 41.2 % between the first and second year and to 0 % after the second year (p < 0.001). Hospital admissions for respiratory illness decreased from 52.9% in the first year to 17.6% in the second year. None of the children were hospitalized after the age of 2 years (p < 0.001).
During the first 2 years of life, children with BPD showed a greater number of admissions and episodes of wheezing and a greater need for medical treatment. Respiratory morbidity improved with age, 40% showed recurrent wheezing episodes at the age of 4 years.
支气管肺发育不良（BPD）是出生后28天存活的早产儿生命最初2年中最常见的呼吸系统发病原因。
通过将一组孕32周出生且患有BPD（孕龄36周时需要吸氧）的早产儿与孕32周出生无BPD的早产儿以及无新生儿疾病的足月婴儿对照组进行比较，评估这组早产儿生命最初2年中的呼吸系统发病率。确定患有BPD的儿童在2岁以后呼吸系统发病率是否降低。
第一组：患有BPD的早产儿（n = 29）。第二组：无BPD的早产儿（n = 29）。第三组：孕龄和体重合适的儿童（n = 32）。对这三组进行了为期2年的横断面描述性研究。第一组中的17名儿童研究延长至4岁。我们分析了至少两次喘息发作、吸入性支气管扩张剂的使用、吸入性糖皮质激素使用超过6个月以及因呼吸道疾病住院的情况。进行了卡方检验和费舍尔精确检验。
第一组25名儿童（86.2%）至少发生过一次喘息发作，第二组为12名儿童（41.4%），第三组为6名（18.8%）。第一组19名儿童（65.5%）接受了超过6个月的吸入性糖皮质激素治疗，其余两组均无（p < 0.001）。第一组25名儿童（86.2%）使用了吸入性支气管扩张剂，第二组为12名（41.4%），对照组为6名（18.8%）（p < 0.001）。第一组12名儿童（41.3%）因呼吸道疾病住院，第二组为8名（27.6%）。对照组无住院情况。接受帕利珠单抗预防的患有BPD的儿童均未感染呼吸道合胞病毒。对17名患有BPD的儿童进行了4岁时的评估。喘息发作从第一年的88.2%降至第三年和第四年之间的41%（p < 0.001）。第一年88.2%的儿童接受了超过6个月的吸入性糖皮质激素治疗，第一和第二年之间为41.2%，第二年以后为0%（p < 0.001）。因呼吸道疾病住院率从第一年的52.9%降至第二年的17.6%。2岁以后无儿童住院（p < 0.001）。
在生命的最初2年中，患有BPD的儿童住院次数更多、喘息发作次数更多，且更需要医疗治疗。呼吸系统发病率随年龄增长而改善，4岁时40%的儿童有反复喘息发作。
