Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.
Division of Neonatology, Department of Pediatrics, Samsung Medical Center, Seoul, Korea.
PLoS One. 2020 Jul 16;15(7):e0235901. doi: 10.1371/journal.pone.0235901. eCollection 2020.
To investigate the risk factors for BPD severity by gestational age (GA) and identify a way to reduce the incidence of moderate-to-severe BPD.
This was a retrospective cohort study of very-low-birth-weight-infants (VLBWIs) delivered at 24 to 28 weeks GA from Korean Neonatal Network registry between 2013 and 2016. BPD was defined using the National Institutes of Health criteria. Study populations were divided by GA and subdivided into no/mild BPD and moderate/severe BPD. The initial statuses of all infants, including those who died before BPD diagnosis and the maternal and neonatal factors of the live infants were compared. Statistical methods included descriptive statistics, comparative tests, and logistic regression.
Of 3,976 infants, 3,717 were included (24weeks, n = 456; 25 weeks, n = 650, 26 weeks, n = 742; 27 weeks, n = 836; 28 weeks, n = 1,033). The overall mortality rate was 18% and the rates by GA were 43%, 29%, 11%, and 6% in the 24-, 25-, 26-, 27-, 28-GA groups, respectively. Small for GA (SGA), treated patent ductus arteriosus (PDA), hypotension, and late-onset sepsis were significant risk factors for developing moderate/severe BPD in the 25 to 28-week GA groups in the multivariate analyses. However, for infants born at 24 weeks GA, there were no significant risk factors apart from initial resuscitation.
Effective initial resuscitation was the most important factor for infants delivered at 24 weeks GA determining the severity of BPD. For infants delivered between 25 and 28 weeks, judicious care of SGA infants, aggressive treatment for PDA and hypotension, and intense efforts to decrease the sepsis rate are needed to reduce the development of moderate-to-severe BPD.
通过研究胎龄（GA）与支气管肺发育不良（BPD）严重程度的关系，确定降低中重度 BPD 发生率的方法。
这是一项回顾性队列研究，纳入了 2013 年至 2016 年期间韩国新生儿网络登记处胎龄为 24 至 28 周的极低出生体重儿（VLBWI）。BPD 采用美国国立卫生研究院的标准进行定义。研究人群根据 GA 进行分组，并细分为无/轻度 BPD 和中重度 BPD。比较所有婴儿（包括在 BPD 诊断前死亡的婴儿）的初始状态和存活婴儿的母亲及新生儿因素。统计学方法包括描述性统计、比较检验和逻辑回归。
纳入 3976 例婴儿，其中 3717 例（24 周：n=456；25 周：n=650；26 周：n=742；27 周：n=836；28 周：n=1033）。总死亡率为 18%，胎龄分别为 24、25、26、27、28 周的婴儿死亡率分别为 43%、29%、11%、6%。多因素分析显示，在 25 至 28 周 GA 组中，小胎龄儿（SGA）、治疗性动脉导管未闭（PDA）、低血压和晚发性败血症是发生中重度 BPD 的显著危险因素。然而，对于 24 周 GA 出生的婴儿，除初始复苏外，无其他显著危险因素。
有效的初始复苏是决定 24 周 GA 出生婴儿 BPD 严重程度的最重要因素。对于 25 至 28 周 GA 出生的婴儿，需要谨慎照顾 SGA 婴儿，积极治疗 PDA 和低血压，并努力降低败血症发生率，以降低中重度 BPD 的发生。
