Ruiz-Peláez Juan G, Charpak Nathalie
Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia.
Fundación Canguro, Bogotá, D.C, Colombia.
Biomedica. 2014 Jan-Mar;34(1):29-39. doi: 10.1590/S0120-41572014000100006.
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.
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).
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.
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.
自2000年以来，人们感觉波哥大的支气管肺发育不良发病率有所上升。本研究对其发病率进行了估算，与历史数据进行了比较，并描述了相关因素。
2004年，我们对来自波哥大12家医疗机构、胎龄≥34周且无重大畸形的早产新生儿进行了前瞻性分析队列研究。主要结局为支气管肺发育不良的发病率和严重程度，并与一个历史队列（1994 - 1999年）进行比较。
新生儿死亡率为80/496，支气管肺发育不良发病率为54.3%（95%置信区间，49.4 - 59.1）。在控制机构类型（低死亡率和高死亡率）后，似乎在低死亡率机构出生可降低死亡风险（比值比=0.308；95%置信区间，0.129 - 0.736），但会增加中度至重度支气管肺发育不良的几率（比值比=1.797；95%置信区间，1.046 - 3.088）。支气管肺发育不良的风险高于历史对照队列（相对危险度=1.924；95%置信区间，1.686 - 2.196）。出生体重和胎龄、机械通气、宫内生长受限以及机构类型（低死亡率与中高死亡率）与支气管肺发育不良严重程度增加甚至死亡独立相关。
波哥大支气管肺发育不良的发生率显著增加，这不能仅通过更脆弱婴儿存活率提高来解释。无论胎龄如何，存活者都有更频繁、更严重的呼吸后遗症。波哥大新生儿重症监护病房最近从有限使用机械通气过渡到几乎普遍使用，可能与次优的积极呼吸护理措施有关，这可能会影响新生儿呼吸护理质量。
