Department of Pediatrics, National Hospital Organization Kokura Medical Center, Fukuoka, Japan.
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Pediatr. 2021 Mar;230:119-125.e7. doi: 10.1016/j.jpeds.2020.11.041. Epub 2020 Nov 24.
To investigate recent trends in bronchopulmonary dysplasia (BPD) and its risk factors among extremely preterm infants.
Demographic and clinical data were reviewed for 19 370 infants born at 22-27 weeks of gestation registered in the affiliated hospitals of the Neonatal Research Network of Japan between 2003 and 2016. We investigated the overall survival and prevalence of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age and risk factors for developing BPD among the survivors.
Among 19 370 infants, 2244 (11.6%) died by 36 weeks' postmenstrual age. The mortality rate decreased from 19.0% (99% CI, 15.7%-22.8%) in 2003 to 8.0% (99% CI, 6.2%-10.3%) in 2016. Among 17 126 survivors, BPD developed in 7792 (45.5%) infants, and its proportion significantly increased from 41.4% (99% CI, 36.5%-46.4%) in 2003 to 52.0% (99% CI, 48.2%-55.9%) in 2016. A multivariable analysis of the survivors showed a positive association of BPD with ≥4 weeks' supplemental oxygen or invasive ventilation, birth weight <750 g, small for gestational age, ≥4 weeks' noninvasive positive pressure ventilation, chorioamnionitis, <26 weeks' gestational age, <20 cases per year of center patient volume, or treated patent ductus arteriosus. Although the median duration of invasive ventilation was shortened, the proportions of factors associated adversely with BPD generally showed increasing trends over time.
The mortality rate of extremely preterm infants has decreased, but the rate of BPD has increased in survivors between 2003 and 2016. Despite the decreasing duration of invasive ventilation over time, increasing rates of BPD suggest that differences in the patient population or other management strategies influence the development of BPD.
研究极早产儿支气管肺发育不良（BPD）的近期趋势及其危险因素。
对 2003 年至 2016 年间在日本新生儿研究网络附属医院出生的 22-27 周龄的 19370 名婴儿的人口统计学和临床数据进行了回顾性分析。我们调查了幸存者在 36 周龄时的总生存率和支气管肺发育不良（BPD）的患病率，以及 BPD 发生的危险因素。
在 19370 名婴儿中，有 2244 名（11.6%）在 36 周龄前死亡。死亡率从 2003 年的 19.0%（99%可信区间，15.7%-22.8%）降至 2016 年的 8.0%（99%可信区间，6.2%-10.3%）。在 17126 名幸存者中，有 7792 名（45.5%）婴儿发生了 BPD，其比例从 2003 年的 41.4%（99%可信区间，36.5%-46.4%）显著增加到 2016 年的 52.0%（99%可信区间，48.2%-55.9%）。对幸存者进行多变量分析表明，BPD 与≥4 周的补充氧或有创通气、出生体重<750g、小于胎龄、≥4 周的无创正压通气、绒毛膜羊膜炎、<26 周的胎龄、每年每中心患者数<20 例或治疗性动脉导管未闭有关。尽管有创通气的中位持续时间缩短，但与 BPD 不良相关的因素比例总体呈上升趋势。
极早产儿的死亡率有所下降，但 2003 年至 2016 年间，幸存者中 BPD 的发生率有所增加。尽管有创通气的持续时间随着时间的推移而缩短，但 BPD 发生率的增加表明患者人群或其他管理策略的差异影响了 BPD 的发展。
