Malavolti Anna Maria, Bassler Dirk, Arlettaz-Mieth Romaine, Faldella Giacomo, Latal Beatrice, Natalucci Giancarlo
Department of Neonatology, University of Zurich and Zurich University Hospital, Zurich, Switzerland.
Department of Gynaecological, Obstetric and Paediatric Sciences, University Hospital of Bologna, Bologna, Italy.
BMJ Paediatr Open. 2018 Jan 9;2(1):e000165. doi: 10.1136/bmjpo-2017-000165. eCollection 2018.
To assess the contribution of the severity of bronchopulmonary dysplasia (BPD) and the time point of its diagnosis to the prediction of neurodevelopmental impairment (NDI) at corrected age of 2 years in preterm infants.
Retrospective cohort study.
Level-III perinatal centre.
Infants born in 2000-2013 with gestational age <30 weeks. BPD was defined as FiO >21% for ≥28 days and its severity classified as mild, FiO=21%; moderate, FiO <30% and severe, FiO ≥30% and/or positive pressure support. We applied these criteria at two time points: 36 and 40 weeks' postmenstrual age (PMA). Multivariable regression models were used to estimate the association (OR (95% CI)) between BPD characteristics and NDI defined as cognitive or motor development score <2 SD; severe cerebral palsy; deafness and blindness.
Of 610 (81% of cohort) children assessed at 2 years, 357 (58%) had BPD and 98 (16%) had NDI. Neither FiO >21% for ≥28 days nor mild or moderate BPD at either 36 or 40 weeks' PMA was associated with NDI, but severe BPD was (at 36 weeks' PMA 5.6 (2.0 to 16.0) and at 40 weeks' PMA 16.6 (4.6 to 59.9)). Infants with severe BPD at both 36 and 40 weeks' PMA had lower mental (mean difference -11.4 (-18.5 to -4.3), -25.7(-35.9 to -15.5), respectively) and motor (-7.8 (-14.9 to -0.6), -20.1(-30.7 to -9.5), respectively), developmental scores than infants without BPD.
In this cohort, severe BPD was a better independent predictor of NDI at 2 years than mild or moderate BPD. BPD diagnosed at 40 weeks' PMA might allow better identification of infants at highest risk for NDI.
评估支气管肺发育不良（BPD）的严重程度及其诊断时间点对早产儿2岁矫正年龄时神经发育障碍（NDI）预测的贡献。
回顾性队列研究。
三级围产期中心。
2000 - 2013年出生、胎龄<30周的婴儿。BPD定义为吸氧浓度（FiO）>21%持续≥28天，其严重程度分为轻度（FiO = 21%）、中度（FiO < 30%）和重度（FiO≥30%和/或需要正压支持）。我们在两个时间点应用这些标准：月经龄（PMA）36周和40周。多变量回归模型用于估计BPD特征与NDI之间关联（比值比（OR（95%置信区间））），NDI定义为认知或运动发育评分<2个标准差；重度脑瘫；耳聋和失明。
在2岁时评估的610名儿童（占队列的81%）中，357名（58%）患有BPD，98名（16%）患有NDI。在36周或40周PMA时，FiO>21%持续≥28天以及轻度或中度BPD均与NDI无关，但重度BPD有关（36周PMA时为5.6（2.0至16.0），40周PMA时为16.6（4.6至59.9））。在36周和40周PMA时均患有重度BPD的婴儿，其智力（平均差异分别为 - 11.4（ - 18.5至 - 4.3）， - 25.7（ - 35.9至 - 15.5））和运动（平均差异分别为 - 7.8（ - 14.9至 - 0.6）， - 20.1（ - 30.7至 - 9.5））发育评分低于无BPD的婴儿。
在该队列中，重度BPD比轻度或中度BPD更能独立预测2岁时的NDI。在40周PMA时诊断的BPD可能有助于更好地识别NDI风险最高的婴儿。
