Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, 1-1-1 Takakuradai, Suma-Ku, Kobe, Hyogo, Japan.
Early Hum Dev. 2013 Feb;89(2):113-7. doi: 10.1016/j.earlhumdev.2012.08.007. Epub 2012 Sep 13.
Elevated cytokine concentrations were observed in tracheal aspirate fluid (TAF) of infants on mechanical ventilation who subsequently developed bronchopulmonary dysplasia (BPD). However, there are few reports that systematically evaluate the amount of TAF as an indicator of BPD development.
To clarify whether TAF volume during the first week of life predicts BPD development in extremely low gestational age newborns (ELGANs).
We analyzed 51 infants, born at gestational age of <28 weeks and ventilated for more than 7 days after birth, among whom, 26 were diagnosed with BPD based on the clinical definition of oxygen dependence at 36 weeks postmenstrual age (BPD group) and 25 were included in the non-BPD group. Sum of TAF scores (STS) was calculated by semi-quantification of TAF volume at each suctioning and the suctioning frequency during the first week of life.
STS was significantly higher in the BPD group than in the non-BPD group (median (interquartile range): 77 (29-126) vs. 28 (22-59), p<0.001). STS (cut-off, 60) with area under the curve in receiver operating analysis of 0.75 was significantly predictive of BPD development. Multivariate logistic regression analysis adjusted for perinatal characteristics showed that STS≥60 was a significant risk factor for BPD development (odds ratio, 7.50; confidence interval, 1.16-48.40, p=0.034).
Increased TAF volume during the first week of life was an independent predictor for BPD development in ventilated ELGANs, indicating that increased pulmonary capillary permeability may influence the pathogenesis of BPD.
机械通气婴儿的气管抽吸物（TAF）中细胞因子浓度升高，随后发展为支气管肺发育不良（BPD）。然而，很少有研究系统地评估 TAF 量作为 BPD 发展的指标。
阐明生命第一周的 TAF 量是否可预测极低出生体重儿（ELGAN）的 BPD 发生。
我们分析了 51 名胎龄<28 周且出生后需通气>7 天的婴儿，其中 26 名根据生后 36 周龄时氧依赖的临床定义诊断为 BPD（BPD 组），25 名纳入非 BPD 组。通过每次抽吸时 TAF 量的半定量评分和生命第一周的抽吸频率计算 TAF 评分总和（STS）。
BPD 组的 STS 明显高于非 BPD 组（中位数（四分位距）：77（29-126）比 28（22-59），p<0.001）。ROC 分析中 STS（截断值，60）的曲线下面积为 0.75，对 BPD 发生具有显著预测价值。调整围生期特征的多变量逻辑回归分析显示，STS≥60 是 BPD 发生的显著危险因素（优势比，7.50；95%置信区间，1.16-48.40，p=0.034）。
通气 ELGAN 生命第一周 TAF 量增加是 BPD 发生的独立预测因子，表明增加的肺毛细血管通透性可能影响 BPD 的发病机制。
