Nobile Stefano, Marchionni Paolo, Carnielli Virgilio P
Department of Maternal and Child Health, Salesi Children's Hospital, Ancona, Italy.
Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy.
Eur J Pediatr. 2017 Aug;176(8):1083-1088. doi: 10.1007/s00431-017-2957-1. Epub 2017 Jun 28.
Small for gestational age (SGA) preterm neonates (birth weight < -2 SDS) are considered to have increased risk of bronchopulmonary dysplasia (BPD) compared to appropriate for GA (AGA) neonates. It is unclear if SGA infants have increased risk for respiratory distress syndrome (RDS) and mortality. We analyzed data from 515 neonates born <30 weeks GA, 98(19%) were SGA. SGA were compared to AGA by univariate analysis and logistic regression analysis (LRA). Significant variables at univariate analysis were IUGR (67 vs 7%, p = 0.000), chorioamnionitis (1 vs 13%, p = 0.017), pre-eclampsia (62 vs 18%, p = 0.000), surfactant retreatment (47 vs 25%, p = 0.000), BPD (32 vs 20%, p = 0.015), death (30 vs 12%, p = 0.000), SatO2/FiO2 on day 3 (376 vs 433, p = 0.013), and SatO2/FiO2 ratio on day 28 (400 vs 448, p = 0.000). LRA found the following associations: regarding mortality, a decreased Sat/FiO2 ratio on day 3 (OR 1.99, 95% CI 1.26-3.16, p = 0.003); regarding BPD, surfactant retreatment (3.70, 2.11-6.49, p = 0.000), being SGA (2.69, 1.36-5.36, p = 0.005), decreasing GA (1.05, 1.03-1.08, p = 0.000), decreasing SatO2/FiO2 ratio on day 3 (1.25, 1.11-1.40, p = 0.000); and regarding severe RDS, pre-eclampsia (2.68, 1.58-4.55, p = 0.000) and decreasing GA (1.06, 1.04-1.08, p = 0.000).
In our cohort of preterm infants, being SGA was significantly associated with BPD, but not with increased risk of mortality or RDS due to multiple pathophysiologic mechanisms. What is Known: • Small for gestational age preterm neonates are considered to have increased risk of bronchopulmonary dysplasia (BPD) compared to appropriate for GA neonates. • It is still unclear if SGA infants have increased risk for respiratory distress syndrome (RDS) and mortality. What is New: • In our cohort of 515 preterm infants (19% SGA), being SGA was significantly associated with BPD, but not with increased risk of mortality or RDS. • These results may be explained by the heterogeneity of mechanisms leading to SGA condition and by multiple mechanisms involving lung growth impairment and other factors.
与适于胎龄（AGA）的新生儿相比，小于胎龄（SGA）的早产新生儿（出生体重＜-2个标准差）被认为患支气管肺发育不良（BPD）的风险增加。目前尚不清楚SGA婴儿发生呼吸窘迫综合征（RDS）和死亡的风险是否增加。我们分析了515例孕龄＜30周出生的新生儿的数据，其中98例（19%）为SGA。通过单因素分析和逻辑回归分析（LRA）将SGA与AGA进行比较。单因素分析中的显著变量有：胎儿生长受限（67%对7%，p = 0.000）、绒毛膜羊膜炎（1%对13%，p = 0.017）、先兆子痫（62%对18%，p = 0.000）、表面活性剂再次治疗（47%对25%，p = 0.000）、BPD（32%对20%，p = 0.015）、死亡（30%对12%，p = 0.000）、第3天的氧饱和度/吸入氧分数（SatO2/FiO2）（376对433，p = 0.013）以及第28天的SatO2/FiO2比值（400对448，p = 0.000）。LRA发现以下关联：关于死亡率，第3天Sat/FiO2比值降低（比值比1.99，95%可信区间1.26 - 3.16，p = 0.003）；关于BPD，表面活性剂再次治疗（3.70，2.11 - 6.49，p = 0.000）、SGA（2.69，1.36 - 5.36，p = 0.005）、孕龄降低（1.05，1.03 - 1.08，p = 0.000）、第3天SatO2/FiO2比值降低（1.25，1.11 - 1.40，p = 0.000）；关于重度RDS，先兆子痫（2.68，1.58 - 4.55，p = 0.000）和孕龄降低（1.06，1.04 - 1.08，p = 0.000）。
在我们的早产婴儿队列中，SGA与BPD显著相关，但由于多种病理生理机制，与死亡或RDS风险增加无关。已知信息：• 与适于胎龄的新生儿相比，小于胎龄的早产新生儿被认为患支气管肺发育不良（BPD）的风险增加。• 目前仍不清楚SGA婴儿发生呼吸窘迫综合征（RDS）和死亡的风险是否增加。新发现：• 在我们515例早产婴儿队列（19%为SGA）中，SGA与BPD显著相关，但与死亡或RDS风险增加无关。• 这些结果可能由导致SGA状态的机制异质性以及涉及肺生长受损和其他因素的多种机制来解释。
