Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Wayne State University, Detroit, MI 48201, USA; Hutzel Women's Hospital, Detroit, MI 48201, USA; Children's Hospital of Michigan, Detroit, MI 48201, USA.
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Wayne State University, Detroit, MI 48201, USA.
Pediatr Neonatol. 2020 Jun;61(3):290-299. doi: 10.1016/j.pedneo.2019.12.001. Epub 2019 Dec 23.
Bronchopulmonary Dysplasia (BPD) is the commonest morbidity in extremely preterm infants (PTIs). Risk factors for BPD have been described in the era before the widespread availability of non-invasive ventilation (NIV) in the delivery room (DR). The objective of this study is to identify risk factors for Moderate/Severe BPD in an era of widespread availability of NIV in the DR.
Detailed antenatal and postnatal data were abstracted for PTIs, 23-27 weeks GA. Multivariate logistic regression and classification and regression tree analyses (CART) identified predictors for the primary outcome of Moderate/Severe BPD.
Of 263 eligible infants, 59% had Moderate/Severe BPD. Moderate/Severe BPD was significantly associated with birthweight, gender, DR intubation and surfactant compared to No/Mild BPD. Of infants not intubated in the DR, 40% with No/Mild BPD and 80% with Moderate/Severe BPD received intubation by 48 hours (p < 0.05). Infants with Moderate/Severe BPD received longer duration of oxygen and mechanical (MV). On logistic regression, birthweight, gender, oxygen concentration, cumulative duration of oxygen and MV, surfactant, and blood transfusions predicted Moderate/Severe BPD. Both CART analysis and logistic regression showed duration of oxygen and MV to be the most important predictors for Moderate/Severe BPD.
In an era of increasing availability of NIV in the DR, lower birthweight, male gender, surfactant treatment, blood transfusions and respiratory support in the first 2-3 weeks after birth predict Moderate/Severe BPD with high sensitivity and specificity. The majority of these infants received intubation within 48 hours of birth (97%). These data suggest that early failures of NIV represent opportunities for improvement of NIV techniques and of non-invasive surfactant to avoid intubation in the first 48 hours. Furthermore, these risk factors may allow earlier identification of infants most likely to benefit from interventions to prevent or decrease severity of BPD.
支气管肺发育不良（BPD）是极早产儿（PTI）最常见的并发症。在分娩室（DR）广泛应用无创通气（NIV）之前，已经描述了 BPD 的危险因素。本研究的目的是在 DR 广泛应用 NIV 的时代，确定中重度 BPD 的危险因素。
详细摘录了 23-27 周胎龄的 PTI 的产前和产后数据。多变量逻辑回归和分类回归树分析（CART）确定了主要结局中度/重度 BPD 的预测因素。
在 263 名合格婴儿中，59%患有中度/重度 BPD。与轻度/无 BPD 相比，中度/重度 BPD 与出生体重、性别、DR 插管和表面活性剂显著相关。在 DR 未插管的婴儿中，40%的轻度/无 BPD 婴儿和 80%的中度/重度 BPD 婴儿在 48 小时内需要插管（p<0.05）。患有中度/重度 BPD 的婴儿接受了更长时间的吸氧和机械通气（MV）。在逻辑回归中，出生体重、性别、氧浓度、吸氧和 MV 累积时间、表面活性剂和输血预测了中度/重度 BPD。CART 分析和逻辑回归均表明，吸氧和 MV 的时间是预测中度/重度 BPD 的最重要指标。
在 DR 中 NIV 应用日益广泛的时代，较低的出生体重、男性、表面活性剂治疗、输血和出生后前 2-3 周的呼吸支持可高度敏感和特异性地预测中度/重度 BPD。这些婴儿中的大多数在出生后 48 小时内接受了插管（97%）。这些数据表明，早期 NIV 失败为改进 NIV 技术和非侵入性表面活性剂以避免出生后 48 小时内插管提供了机会。此外，这些危险因素可能有助于更早识别最有可能受益于预防或减少 BPD 严重程度的干预措施的婴儿。
