早产与呼吸结局项目中支气管肺发育不良当前定义的比较及局限性
Comparisons and Limitations of Current Definitions of Bronchopulmonary Dysplasia for the Prematurity and Respiratory Outcomes Program.
作者信息
Poindexter Brenda B, Feng Rui, Schmidt Barbara, Aschner Judy L, Ballard Roberta A, Hamvas Aaron, Reynolds Anne Marie, Shaw Pamela A, Jobe Alan H
机构信息
1 Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
2 Indiana University School of Medicine, Indianapolis, Indiana.
出版信息
Ann Am Thorac Soc. 2015 Dec;12(12):1822-30. doi: 10.1513/AnnalsATS.201504-218OC.
RATIONALE
Bronchopulmonary dysplasia is the most common morbidity of prematurity, but the validity and utility of commonly used definitions have been questioned.
OBJECTIVES
To compare three commonly used definitions of bronchopulmonary dysplasia in a contemporary prospective, multicenter observational cohort of extremely preterm infants.
METHODS
At 36 weeks postmenstrual age, the following definitions of bronchopulmonary dysplasia were applied to surviving infants with and without imputation: need for supplemental oxygen (Shennan definition), National Institutes of Health Workshop definition, and "physiologic" definition after a room-air challenge.
MEASUREMENTS AND MAIN RESULTS
Of 765 survivors assessed at 36 weeks, bronchopulmonary dysplasia was diagnosed in 40.8, 58.6, and 32.0% of infants, respectively, with the Shennan, workshop and physiologic definitions. The number of unclassified infants was lowest with the workshop definition (2.1%) and highest with the physiologic definition (16.1%). After assigning infants discharged home in room air before 36 weeks as no bronchopulmonary dysplasia, the modified Shennan definition compared favorably to the workshop definition, with 2.9% unclassified infants. Newer management strategies with nasal cannula flows up to 4 L/min or more and 0.21 FiO2 at 36 weeks obscured classification of bronchopulmonary dysplasia status in 12.4% of infants.
CONCLUSIONS
Existing definitions of bronchopulmonary dysplasia differ with respect to ease of data collection and number of unclassifiable cases. Contemporary changes in management of infants, such as use of high-flow nasal cannula, limit application of existing definitions and may result in misclassification. A contemporary definition of bronchopulmonary dysplasia that correlates with respiratory morbidity in childhood is needed. Clinical trial registered with www.clinicaltrials.gov (NCT01435187).
理论依据
支气管肺发育不良是早产儿最常见的发病情况，但常用定义的有效性和实用性受到了质疑。
目的
在当代一个前瞻性、多中心观察性队列研究中，比较三种常用的支气管肺发育不良定义在极早产儿中的应用情况。
方法
在孕龄36周时，将以下支气管肺发育不良的定义应用于存活婴儿，无论是否进行数据插补：需要补充氧气（Shennan定义）、美国国立卫生研究院研讨会定义以及在空气吸入试验后的“生理学”定义。
测量指标和主要结果
在36周时评估的765名存活婴儿中，根据Shennan定义、研讨会定义和生理学定义，分别有40.8%、58.6%和32.0%的婴儿被诊断为支气管肺发育不良。未分类婴儿的数量以研讨会定义最低（2.1%），以生理学定义最高（16.1%）。在将36周前出院时呼吸空气的婴儿判定为无支气管肺发育不良后，改良的Shennan定义与研讨会定义相比更具优势，未分类婴儿为2.9%。在36周时采用高达4升/分钟或更高的鼻导管流量和0.21的吸入氧分数等新的管理策略，使12.4%的婴儿支气管肺发育不良状态的分类变得模糊。
结论
支气管肺发育不良的现有定义在数据收集的难易程度和无法分类的病例数量方面存在差异。婴儿管理方面的当代变化，如使用高流量鼻导管，限制了现有定义的应用，可能导致分类错误。需要一个与儿童期呼吸疾病相关的支气管肺发育不良的当代定义。在www.clinicaltrials.gov注册的临床试验（NCT01435187）。
Zotero 插件