Ding Li, Wang Huawei, Geng Haifeng, Cui Ningxun, Huang Fengxia, Zhu Xueping, Zhu Xiaoli
Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China.
Department of Intervention, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Pediatr. 2020 Jun 26;8:349. doi: 10.3389/fped.2020.00349. eCollection 2020.
To identify postnatal risk factors for bronchopulmonary dysplasia (BPD) development in preterm infants with gestational age ≤32 weeks. Seventy-two preterm infants(30 with BPD and 42 non-BPD controls) admitted in the neonatal intensive care unit (NICU) of the Children's Hospital of Soochow University during 2017 were enrolled in this prospective longitudinal study. Perinatal clinical data, a neonatal critical illness score (NCIS), different soluble B7-H3(sB7-H3), and interleukin-18 (IL-18) levels by days after birth were collected. An early predictive model for BPD development was established based on clinical data using multiple logistic regression analysis. And the sensitivity and specificity of the model were assesed by ROC curve. Electrolyte disturbances, hemodynamically significant patent ductus arteriosus (hs-PDA), and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth were found to be associated with the BPD pathogenesis. Serum sB7-H3, IL-18, and NCIS were significantly higher in the BPD group compared to the non-BPD group ( < 0.05). BPD group had significantly lower enteral fluid and caloric intake compared to the non-BPD group at 1, 7, 14, and 28 days after birth. The risk factors were analyzed by multiple logistic regression and a predictive model of a combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors was evaluated via ROC curve with an area under the curve (AUC) of 0.960 having sensitivity of 86.7% and a specificity of 97.6%, respectively. The causes of BPD are multifactorial postnatal risk factors. And the combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors (electrolyte disturbances, hs-PDA, and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth) might be served as an optimal predictive model for the occurrence of BPD.
确定胎龄≤32周的早产儿发生支气管肺发育不良（BPD）的产后危险因素。2017年期间，苏州大学附属儿童医院新生儿重症监护病房（NICU）收治的72例早产儿（30例BPD患儿和42例非BPD对照）纳入了这项前瞻性纵向研究。收集围产期临床数据、新生儿危重病评分（NCIS）、不同时间点出生后可溶性B7-H3（sB7-H3）和白细胞介素-18（IL-18）水平。基于临床数据，采用多因素逻辑回归分析建立BPD发生的早期预测模型。并通过ROC曲线评估模型的敏感性和特异性。发现电解质紊乱、血流动力学显著的动脉导管未闭（hs-PDA）以及出生后≥40天经肠道喂养达到120 kcal/kg.d的年龄与BPD发病机制相关。与非BPD组相比，BPD组血清sB7-H3、IL-18和NCIS显著更高（<0.05）。出生后1、7、14和28天，BPD组经肠道摄入的液体和热量显著低于非BPD组。通过多因素逻辑回归分析危险因素，并通过ROC曲线评估sB7-H3（第7天）、IL-18（第14天）、NCIS和临床危险因素组合的预测模型，曲线下面积（AUC）为0.960，敏感性为86.7%，特异性为97.6%。BPD的病因是多因素的产后危险因素。sB7-H3（第7天）、IL-18（第14天）、NCIS和临床危险因素（电解质紊乱、hs-PDA以及出生后≥40天经肠道喂养达到120 kcal/kg.d的年龄）的组合可能是BPD发生的最佳预测模型。
