Lio Alessandra, Rosati Paolo, Pastorino Roberta, Cota Francesco, Tana Milena, Tirone Chiara, Aurilia Claudia, Ricci Cinzia, Gambacorta Alessandro, Paladini Angela, Mappa Ilenia, Buongiorno Silvia, Zannoni Gian Franco, Romagnoli Costantino, Vento Giovanni
Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy.
BMJ Open. 2017 Jul 20;7(7):e015232. doi: 10.1136/bmjopen-2016-015232.
To investigate whether fetal growth restriction (FGR) diagnosis, based on pathological prenatal fetal Doppler velocimetry, is associated with bronchopulmonary dysplasia (BPD) independently of being small for gestational age (SGA) per se at birth among very preterm infants.
Prospective, observational study. FGR was defined as failing fetal growth in utero and fetal Doppler velocimetry abnormalities.
Policlinico Universitario Agostino Gemelli, Roma, Italy.
Preterm newborns with gestational age ≤30 weeks and birth weight (BW) ≤1250 g.
Bronchopulmonary dysplasia.
In the study period, 178 newborns were eligible for the study. Thirty-nine infants (22%) were considered fetal growth-restricted infants. Among the 154 survived babies at 36 weeks postmenstrual age, 12 out of 36 (33%) of the FGR group developed BPD versus 8 out of 118 (7%) of the NO-FGR group (p<0.001). BPD rate was sixfold higher among the SGA-FGR infants compared with the SGA-NO-FGR infants. In a multivariable model, FGR was significantly associated with BPD risk (OR 5.1, CI 1.4 to 18.8, p=0.01), independently from BW z-score that still remains a strong risk factor (OR 0.5, CI 0.3 to 0.9, p=0.01).
Among SGA preterm infants, BPD risk dramatically increases when placenta dysfunction is the surrounding cause of low BW. Antenatal fetal Doppler surveillance could be a useful tool for studying placenta wellness and predicting BPD risk among preterm babies. Further research is needed to better understand how FGR affects lung development.
探讨基于产前病理胎儿多普勒血流测定法诊断的胎儿生长受限（FGR），在极早产儿中，是否独立于出生时小于胎龄（SGA）本身，而与支气管肺发育不良（BPD）相关。
前瞻性观察性研究。FGR定义为子宫内胎儿生长失败及胎儿多普勒血流测定异常。
意大利罗马的阿戈斯蒂诺·杰梅利大学综合医院。
孕周≤30周且出生体重（BW）≤1250 g的早产儿。
支气管肺发育不良。
在研究期间，178例新生儿符合研究条件。39例婴儿（22%）被视为胎儿生长受限婴儿。在154例孕龄36周时存活的婴儿中，FGR组36例中有12例（33%）发生BPD，而非FGR组118例中有8例（7%）发生BPD（p<0.001）。SGA-FGR婴儿的BPD发生率比SGA-非FGR婴儿高6倍。在多变量模型中，FGR与BPD风险显著相关（比值比5.1，可信区间1.4至18.8，p=0.01），独立于BW z评分，BW z评分仍是一个强风险因素（比值比0.5，可信区间0.3至0.9，p=0.01）。
在SGA早产儿中，当胎盘功能障碍是低体重的周围原因时，BPD风险会显著增加。产前胎儿多普勒监测可能是研究胎盘健康状况和预测早产儿BPD风险的有用工具。需要进一步研究以更好地了解FGR如何影响肺发育。
