Park Ga Young, Park Won Soon, Sung Se In, Kim Min Sun, Lee Myung Hee, Jeon Ga Won, Kim Sung Shin, Chang Yun Sil
Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, South Korea.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Matern Fetal Neonatal Med. 2022 Apr;35(7):1286-1294. doi: 10.1080/14767058.2020.1749590. Epub 2020 May 6.
To determine the outcomes of very low birth weight infants (VLBWIs) following maternal mid-trimester prolonged preterm premature rupture of membranes (PPROM) and subsequent early pulmonary hypertension (PH).
Prospective cohort study.
A nationwide web-based registry of VLBWIs from 67 neonatal intensive care units.
VLBWIs registered on the Korean Neonatal Network and born between 23 and 34 gestational weeks.
VLBWIs exposed to maternal PPROM prior to 25 gestational weeks and lasting ≥7 days (PPROM25, = 402) were matched 1:1 with infants not exposed or exposed within 24 h to PPROM (CON, = 402), using propensity score matching. The PPROM25 group was subdivided into PPROM25 groups with or without early PH, defined as exposure to inhaled nitric oxide or other pulmonary vasodilators to treat PH within 3 days of life. Clinical variables and major outcomes were compared, and risk factors for mortality and morbidities were analyzed.
Of 1790 infants with maternal PPROM, the PPROM25 group comprised 402 (22.5%) infants. Survival rates were similar between the CON and PPROM25 groups (71.6% vs 74.4%); however, the incidence of bronchopulmonary dysplasia (BPD) differed (47.8% and 60.2%, < .05). Infants in the PPROM25 group with early PH had higher mortality (55.6%) and more severe intraventricular hemorrhage (IVH) (31.7%) than infants in the PPROM25 group without early PH (21.9% and 14.3%, respectively; < .05). In multivariate analysis, lower 5 min Apgar score and the presence of oligohydramnios increased the risk of development of early PH. The presence of PPROM25 was founded to be a significant risk factor for BPD and early PH in relation to mortality and severe IVH, respectively.
In VLBWIs, prolonged exposure to maternal mid-trimester PPROM increased the risk of BPD. Subsequent early PH immediately after birth increased mortality and severe IVH, thus, requires special attention.
确定孕中期孕妇发生胎膜早破（PPROM）并随后出现早期肺动脉高压（PH）的极低出生体重儿（VLBWIs）的预后情况。
前瞻性队列研究。
一个基于网络的全国性VLBWIs登记处，来自67个新生儿重症监护病房。
在韩国新生儿网络登记的、孕周在23至34周之间出生的VLBWIs。
将妊娠25周前暴露于孕妇PPROM且持续时间≥7天（PPROM25，n = 402）的VLBWIs与未暴露或在24小时内暴露于PPROM的婴儿（对照组，n = 402）进行1:1倾向评分匹配。PPROM25组再细分为有或无早期PH的PPROM25组，早期PH定义为在出生后3天内接受吸入一氧化氮或其他肺血管扩张剂治疗PH。比较临床变量和主要结局，并分析死亡和发病的危险因素。
在1790例有孕妇PPROM的婴儿中，PPROM25组包括402例（22.5%）婴儿。对照组和PPROM25组的生存率相似（71.6%对74.4%）；然而，支气管肺发育不良（BPD）的发生率不同（47.8%和60.2%，P <.05）。PPROM25组中有早期PH的婴儿比没有早期PH的PPROM25组婴儿死亡率更高（55.6%），脑室内出血（IVH）更严重（31.7%）（分别为21.9%和14.3%；P <.05）。在多变量分析中，5分钟阿氏评分较低和羊水过少会增加早期PH发生的风险。发现PPROM25分别是BPD和与死亡及严重IVH相关的早期PH的重要危险因素。
在VLBWIs中，长时间暴露于孕中期孕妇PPROM会增加BPD的风险。出生后随即出现的早期PH会增加死亡率和严重IVH，因此需要特别关注。
