气管支气管软化与支气管肺发育不良的发病率增加相关。
Tracheobronchomalacia Is Associated with Increased Morbidity in Bronchopulmonary Dysplasia.
作者信息
Hysinger Erik B, Friedman Nicholas L, Padula Michael A, Shinohara Russell T, Zhang Huayan, Panitch Howard B, Kawut Steven M
机构信息
Children's Hospital of Philadelphia, Pulmonary Medicine , 34th St. and Civic Center Blvd , Philadelphia, Pennsylvania, United States , 19104 ;
University of Pennsylvania, 6572, Pediatrics, Philadelphia, Pennsylvania, United States ;
出版信息
Ann Am Thorac Soc. 2017 Sep 1;14(9):1428-35. doi: 10.1513/AnnalsATS.201702-178OC. Epub 2017 Jun 16.
RATIONALE
Tracheobronchomalacia is a common comorbidity in neonates with bronchopulmonary dysplasia. However, the effect of tracheobronchomalacia on the clinical course of bronchopulmonary dysplasia is not well-understood.
OBJECTIVE
We sought to assess the impact of tracheobronchomalacia on outcomes in neonates with bronchopulmonary dysplasia in a large, multi-center cohort.
METHODS
We preformed a cohort study of 974 neonates with bronchopulmonary dysplasia admitted to 27 neonatal intensive care units participating in the Children's Hospital Neonatal Database who had undergone bronchoscopy. In hospital morbidity for neonates with bronchopulmonary dysplasia and tracheobronchomalacia (N=353, 36.2%) was compared to those without tracheobronchomalacia (N=621, 63.8%) using mixed-effects multivariate regression.
RESULTS
Neonates with tracheobronchomalacia and bronchopulmonary dysplasia had more comorbidities, such as gastroesophageal reflux (OR=1.65, 95%CI 1.23- 2.29, P=0.001) and pneumonia (OR=1.68, 95%CI 1.21-2.33, P=0.002) and more commonly required surgeries such as tracheostomy (OR=1.55, 95%CI 1.15-2.11, P=0.005) and gastrostomy (OR=1.38, 95%CI 1.03-1.85, P=0.03) compared with those without tracheobronchomalacia. Neonates with tracheobronchomalacia were hospitalitized (118 ± 93 vs 105 ± 83 days, P=0.02) and ventilated (83.1 ± 91.1 vs 67.2 ± 71.9 days, P=0.003) longer than those without tracheobronchomalacia. Upon discharge, neonates with tracheobronchomalacia and BPD were more likely to be mechanically ventilated (OR=1.37, 95CI 1.01-1.87 P=0.045) and possibly less likely to receive oral nutrition (OR=0.69, 95%CI 0.47-1.01, P=0.058).
CONCLUSIONS
Tracheobronchomalacia is common in neonates with bronchopulmonary dysplasia who undergo bronchoscopy and is associated with longer and more complicated hospitalizations.
理论依据
气管支气管软化是支气管肺发育不良新生儿的常见合并症。然而，气管支气管软化对支气管肺发育不良临床病程的影响尚不清楚。
目的
我们试图在一个大型多中心队列中评估气管支气管软化对支气管肺发育不良新生儿预后的影响。
方法
我们对参与儿童医院新生儿数据库的27个新生儿重症监护病房收治的974例接受支气管镜检查的支气管肺发育不良新生儿进行了队列研究。使用混合效应多变量回归比较了患有支气管肺发育不良和气管支气管软化的新生儿（n = 353，36.2%）与无气管支气管软化的新生儿（n = 621，63.8%）的院内发病率。
结果
与无气管支气管软化的新生儿相比，患有气管支气管软化和支气管肺发育不良的新生儿有更多合并症，如胃食管反流（比值比=1.65，95%置信区间1.23 - 2.29，P = 0.001）和肺炎（比值比=1.68，95%置信区间1.21 - 2.33，P = 0.002），更常需要进行诸如气管造口术（比值比=1.55，95%置信区间1.15 - 2.11，P = 0.005）和胃造口术（比值比=1.38，95%置信区间1.03 - 1.85，P = 0.03）等手术。患有气管支气管软化的新生儿住院时间（118±93天对105±83天，P = 0.02）和机械通气时间（83.1±91.1天对67.2±71.9天，P = 0.003）比无气管支气管软化的新生儿更长。出院时，患有气管支气管软化和支气管肺发育不良的新生儿更有可能需要机械通气（比值比=1.37，95%置信区间1.01 - 1.87，P = 0.045），接受口服营养的可能性可能更低（比值比=0.69，95%置信区间0.47 - 1.01，P = 0.058）。
结论
气管支气管软化在接受支气管镜检查的支气管肺发育不良新生儿中很常见，并且与更长、更复杂的住院时间相关。
Zotero 插件