Sucasas Alonso Andrea, Pértega Díaz Sonia, Sáez Soto Rebeca, Ávila-Álvarez Alejandro
Unidad de Neonatología, Servicio de Pediatría, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, A Coruña, España.
Unidad de Apoyo a la Investigación, Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS. Universidade da Coruña (UDC), A Coruña, España.
An Pediatr (Engl Ed). 2021 Apr 1. doi: 10.1016/j.anpedi.2021.03.002.
To describe risk factors of bronchopulmonary dysplasia in very preterm infants in the first weeks of life.
Retrospective cohort study of preterm infants ≤ 32 weeks of gestational age and birth weight ≤ 1500 g. A multivariate logistic regression analysis was performed to identify independent risk factors for bronchopulmonary dysplasia in the first weeks of life.
A total of 202 newborns were included in the study (mean gestational age 29.5 ± 2.1 weeks), 61.4% never received invasive mechanical ventilation. The incidence of bronchopulmonary dysplasia was 28.7%, and 10.4% of the patients were diagnosed with moderate-severe bronchopulmonary dysplasia. Bronchopulmonary dysplasia was independently associated with gestational age at birth (p < 0.001; OR = 0.44 [95% CI = 0.30-0.65]), the need for mechanical ventilation on the first day of life (p = 0.001; OR = 8.13 [95% CI = 2.41-27.42]), nosocomial sepsis (p < 0.001; OR = 9.51 [95% CI = 2.99-30.28]) and FiO on day 14 (p < 0.001; OR = 1.39 [95% CI = 1.16-1.66]). Receiving mechanical ventilation at the first day of life (p = 0.008; OR = 5.39 [95% CI = 1.54-18.89]) and at the third day of life (p = 0.001; OR = 9.99 [95% CI = 2.47-40.44]) and nosocomial sepsis (p = 0.001; OR = 9.87 [95% CI = 2.58-37.80]) were independent risk factors for moderate-severe bronchopulmonary dysplasia.
Gestational age at birth, mechanical ventilation in the first days of life and nosocomial sepsis are early risk factors for bronchopulmonary dysplasia. The analysis of simple and objective clinical data, allows us to select a group of patients at high risk of bronchopulmonary dysplasia in whom it could be justified to act more aggressively, and shows areas for improvement to prevent its development or reduce its severity.
描述极早产儿出生后最初几周发生支气管肺发育不良的危险因素。
对孕周≤32周且出生体重≤1500g的早产儿进行回顾性队列研究。进行多因素逻辑回归分析以确定出生后最初几周支气管肺发育不良的独立危险因素。
本研究共纳入202例新生儿（平均孕周29.5±2.1周），61.4%从未接受有创机械通气。支气管肺发育不良的发生率为28.7%，10.4%的患者被诊断为中重度支气管肺发育不良。支气管肺发育不良与出生时的孕周独立相关（p<0.001；OR=0.44[95%CI=0.30-0.65]）、出生第一天需要机械通气（p=0.001；OR=8.13[95%CI=2.41-27.42]）、医院感染性败血症（p<0.001；OR=9.51[95%CI=2.99-30.28]）以及出生后第14天的吸入氧分数（p<0.001；OR=1.39[95%CI=1.16-1.66]）有关。出生第一天（p=0.008；OR=5.39[95%CI=1.54-18.89]）和第三天（p=0.001；OR=9.99[95%CI=2.47-40.44]）接受机械通气以及医院感染性败血症（p=0.001；OR=9.87[95%CI=2.58-37.80]）是中重度支气管肺发育不良的独立危险因素。
出生时的孕周、出生后最初几天的机械通气以及医院感染性败血症是支气管肺发育不良的早期危险因素。对简单客观的临床数据进行分析，使我们能够选出一组支气管肺发育不良高危患者，对其采取更积极的措施可能是合理的，并显示出预防其发生或减轻其严重程度的改进方向。
