van Mastrigt Esther, Kakar Ellaha, Ciet Pierluigi, den Dekker Herman T, Joosten Koen F, Kalkman Patricia, Swarte Renate, Kroon André A, Tiddens Harm A W M, de Jongste Johan C, Reiss Irwin, Duijts Liesbeth, Pijnenburg Mariëlle W
Division of Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Pediatr Pulmonol. 2017 Aug;52(8):1029-1037. doi: 10.1002/ppul.23696. Epub 2017 Jul 3.
Bronchopulmonary dysplasia (BPD) is the most frequent serious complication in preterm infants. We aimed to describe lung structure and ventilatory function of preterm infants with severe BPD and explored the association between early postnatal growth and these outcomes.
We included preterm infants born ≤32 weeks gestational age (GA) with severe BPD. Lung structure was assessed on chest CT with the PRAGMA-BPD scoring system and ventilatory function by polysomnography (PSG) at 6 months corrected age. Postnatal growth was assessed by weight measured at birth, and at 2 and 6 months corrected age.
We included 49 infants (median [IQR] GA of 25.7 [24.6-26.3] weeks and mean [SD] birth weight of 760 [210] g). A 95.5% of the chest CT scans showed architectural distortion of the lung, and an oxygen desaturation index (ODI) >5 was found in 74% of the infants. An increase in GA of 1 week was associated with higher total and normal lung volume (β coefficient [95% CI]: 1.86 [0.15, 3.57] and 2.03 [0.41, 3.65]), less hypoattenuation (-4.3 [-7.70, -0.90]%) and lower ODI (-36.7 [-64.2, -9.10]%). Higher weight at 6 months was independently associated with higher total and normal lung volume, and with less severe desaturations. Increased weight gain between 2 and 6 months of corrected age was associated with less severe desaturations during sleep (β coefficient [95% CI]: 2.09 [0.49, 3.70]).
Most preterm infants with severe BPD have structural lung abnormalities and impaired ventilatory function early in life, partly explained by birth characteristics and infant growth.
支气管肺发育不良（BPD）是早产儿最常见的严重并发症。我们旨在描述重度BPD早产儿的肺结构和通气功能，并探讨出生后早期生长与这些结局之间的关联。
我们纳入了胎龄（GA）≤32周且患有重度BPD的早产儿。在矫正年龄6个月时，采用PRAGMA - BPD评分系统通过胸部CT评估肺结构，并通过多导睡眠图（PSG）评估通气功能。通过出生时、矫正年龄2个月和6个月时测量的体重评估出生后生长情况。
我们纳入了49例婴儿（GA中位数[四分位间距]为25.7[24.6 - 26.3]周，出生体重均值[标准差]为760[210]g）。95.5%的胸部CT扫描显示肺部结构扭曲，74%的婴儿氧饱和度下降指数（ODI）>5。GA每增加1周与更高的总肺容积和正常肺容积相关（β系数[95%置信区间]：1.86[0.15, 3.57]和2.03[0.41, 3.65]），更低的低密度影（-4.3[-7.70, -0.90]%）和更低的ODI（-36.7[-64.2, -9.10]）。矫正年龄6个月时更高的体重独立地与更高的总肺容积和正常肺容积以及更轻的饱和度下降相关。矫正年龄2个月至6个月期间体重增加与睡眠期间更轻的饱和度下降相关（β系数[95%置信区间]：2.09[0.49, 3.70]）。
大多数重度BPD早产儿在生命早期存在肺部结构异常和通气功能受损，部分原因可由出生特征和婴儿生长情况解释。
