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支气管肺发育不良:两种最常用诊断标准的比较

Bronchopulmonary Dysplasia: Comparison Between the Two Most Used Diagnostic Criteria.

作者信息

Gomez Pomar Enrique, Concina Vanessa A, Samide Aaron, Westgate Philip M, Bada Henrietta S

机构信息

Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, United States.

Department of Pediatrics, Johns Hopkins All Children's Hospital in Florida, St. Petersburg, FL, United States.

出版信息

Front Pediatr. 2018 Dec 12;6:397. doi: 10.3389/fped.2018.00397. eCollection 2018.


DOI:10.3389/fped.2018.00397
PMID:30619792
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6299117/
Abstract

To compare the Shennan's and the consensus definition of Bronchopulmonary Dysplasia (BPD) from the National Institutes of Health (NIH) workshop and analyze specific risk factors associated with each definition. Retrospective analysis of records of 274 infants admitted to a level IV intensive care unit. Infants were classified as having BPD or no BPD by both definitions. Differences in incidence and risk factors were analyzed. Statistical methods included descriptive statistics, comparative tests, and marginal logistic regression modeling. The estimated difference in prevalence was 32% [95% CI: (26%, 37%), ( < 0.0001)] between both criteria. The prevalence of BPD was 80% higher based on the NIH criteria [RR = 1.80; 95% CI: (1.58, 2.06)]. Infants with no BPD by the Shennan definition were breathing room air with or without positive or continuous pressure support and were most likely to be discharged home on oxygen [OR = 4.47, 95% CI: (1.20, 16.61), = 0.03]. Gestational age, birth weight, and 1-min Apgar score predicted BPD by both definitions. Chorioamnionitis increased the risk of BPD by the Shennan definition but was associated with lower risk by the NIH criteria. IUGR was associated with BPD by the Shennan definition and with severe BPD by the NIH criteria. Compared to the Shennan's definition, the NIH consensus identified 80% more infants with BPD and is a better predictor of oxygen requirement at discharge. Until a new better criteria is develop, the NIH consensus definition should be used across centers.

摘要

比较深圳市儿童医院定义与美国国立卫生研究院(NIH)研讨会对支气管肺发育不良(BPD)的共识定义,并分析与每种定义相关的特定风险因素。对274名入住四级重症监护病房的婴儿的记录进行回顾性分析。根据这两种定义,将婴儿分为患有BPD或未患BPD。分析发病率和风险因素的差异。统计方法包括描述性统计、比较检验和边际逻辑回归建模。两种标准之间估计的患病率差异为32%[95%CI:(26%,37%),(<0.0001)]。根据NIH标准,BPD的患病率高出80%[RR = 1.80;95%CI:(1.58,2.06)]。按照深圳市儿童医院定义未患BPD的婴儿,无论有无正压或持续气道正压支持,均在呼吸室内空气,且最有可能在出院时带氧回家[OR = 4.47,95%CI:(1.20,16.61),P = 0.03]。两种定义下,胎龄、出生体重和1分钟阿氏评分均能预测BPD。绒毛膜羊膜炎按照深圳市儿童医院定义增加了BPD风险,但根据NIH标准,其风险较低。宫内生长受限按照深圳市儿童医院定义与BPD相关,而根据NIH标准与重度BPD相关。与深圳市儿童医院定义相比,NIH共识确定的BPD婴儿多80%,并且是出院时氧需求的更好预测指标。在制定出新的更好标准之前,各中心应采用NIH共识定义。

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本文引用的文献

[1]
Bronchopulmonary Dysplasia: Can We Agree on a Definition?

Am J Perinatol. 2018-5

[2]
Ventilation in Extremely Preterm Infants and Respiratory Function at 8 Years.

N Engl J Med. 2017-7-27

[3]
How to decrease bronchopulmonary dysplasia in your neonatal intensive care unit today and "tomorrow".

F1000Res. 2017-4-21

[4]
The Evolution of Bronchopulmonary Dysplasia after 50 Years.

Am J Respir Crit Care Med. 2017-2-15

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Risk Factors for Development of Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia: Systematic Review and Meta-Analysis.

Paediatr Respir Rev. 2016-11-22

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Bronchopulmonary dysplasia: new becomes old again!

Pediatr Res. 2017-1

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Association of Noninvasive Ventilation Strategies With Mortality and Bronchopulmonary Dysplasia Among Preterm Infants: A Systematic Review and Meta-analysis.

JAMA. 2016-8-9

[8]
Trends in Survival and Incidence of Bronchopulmonary Dysplasia in Extremely Preterm Infants at 23-26 Weeks Gestation.

J Korean Med Sci. 2016-3

[9]
Comparisons and Limitations of Current Definitions of Bronchopulmonary Dysplasia for the Prematurity and Respiratory Outcomes Program.

Ann Am Thorac Soc. 2015-12

[10]
Hospital variation and risk factors for bronchopulmonary dysplasia in a population-based cohort.

JAMA Pediatr. 2015-2-2

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