Eriksson Lena, Haglund Bengt, Odlind Viveca, Altman Maria, Ewald Uwe, Kieler Helle
Centre for Pharmacoepidemiology and Unit of Clinical Epidemiology, Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden; Medical Products Agency, Uppsala, Sweden.
Acta Paediatr. 2015 Mar;104(3):259-63. doi: 10.1111/apa.12888. Epub 2015 Jan 30.
Bronchopulmonary dysplasia (BPD) is a frequent chronic lung disease in preterm infants, and we aimed to identify factors associated with this condition in infants with respiratory distress syndrome (RDS).
This case-control study, using national Swedish data, included 2255 preterm infants, born before 33 gestational weeks. The 667 BPD cases were oxygen dependent at 36 weeks' postmenstrual age, and the 1558 controls only had RDS. Comparisons included perinatal conditions and pharmacological treatments. Adjusted odds ratios with 95% confidence intervals were calculated in a conditional logistic regression model, with gestational age as the conditioning term.
An increased risk of BPD was associated with prelabour preterm rupture of membranes of more than 1 week (3.35, 2.16-5.19), small for gestational age (2.73, 2.11-3.55), low Apgar score (1.37, 1.05-1.81), patent ductus arteriosus (1.70, 1.33-2.18), persistent pulmonary hypertension (5.80, 3.21-10.50), pulmonary interstitial emphysema (2.78, 1.37-5.64), pneumothorax (2.95, 1.85-4.72), late onset infections (2.69, 1.82-3.98), intubation (1.56, 1.20-2.03), chest compressions (2.05, 1.15-3.66) and mechanical ventilation (2.16, 1.69-2.77), but not antenatal corticosteroids.
Growth restriction and inflammation increased the risk of BPD in preterm infants and prelabour preterm rupture of membranes, small for gestational age, low Apgar score or need for resuscitation should raise clinical suspicions.
支气管肺发育不良（BPD）是早产儿常见的慢性肺部疾病，我们旨在确定呼吸窘迫综合征（RDS）患儿中与该疾病相关的因素。
本病例对照研究使用瑞典全国数据，纳入2255例孕周小于33周的早产儿。667例BPD病例在孕龄36周时仍需吸氧，1558例对照仅患有RDS。比较内容包括围产期情况和药物治疗。在以胎龄为条件项的条件逻辑回归模型中计算调整后的比值比及95%置信区间。
BPD风险增加与胎膜早破超过1周（3.35，2.16 - 5.19）、小于胎龄儿（2.73，2.11 - 3.55）、阿氏评分低（1.37，1.05 - 1.81）、动脉导管未闭（1.70，1.33 - 2.18）、持续性肺动脉高压（5.80，3.21 - 10.50）、肺间质气肿（2.78，1.37 - 5.64）、气胸（2.95，1.85 - 4.72）、晚发性感染（2.69，1.82 - 3.98）、插管（1.56，1.20 - 2.03）、胸外按压（2.05，1.15 - 3.66）和机械通气（2.16，1.69 - 2.77）相关，但与产前使用糖皮质激素无关。
生长受限和炎症增加了早产儿患BPD的风险，胎膜早破、小于胎龄儿、阿氏评分低或需要复苏应引起临床怀疑。
