Kim Hye-Rim, Jung Young Hwa, Kim Beyong Il, Kim So Young, Choi Chang Won
Department of Pediatrics, Bundang CHA Medical Center, CHA University, Seongnam, South Korea.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Front Pediatr. 2021 Jul 2;9:664033. doi: 10.3389/fped.2021.664033. eCollection 2021.
The present study compared baseline characteristics, comorbidities and clinical burden of pre-term infants with type 1 and 2 severe bronchopulmonary dysplasia (BPD) Collaborative classification. This study was a prospective cohort study of pre-term (<32 weeks) very-low-birth-weight infants. Severe BPD was divided into type 1 severe BPD requiring of ≥30% oxygen and/or non-invasive ventilation at 36 weeks post-menstrual age (PMA), and type 2 severe BPD requiring invasive mechanical ventilation at 36 weeks PMA. Baseline characteristics, comorbidities, and clinical burden were compared between these two types of severe BPD. Of the 1,328 infants included, 983 (74.0%) developed type 1 severe BPD, and 345 (26.0%) developed type 2 severe BPD. Lower birth weight, small for gestational age, lesser maternal pre-mature rupture of membrane, lower 5-min Apgar score, air leak, pulmonary hemorrhage, surgical ligation of patent ductus arteriosus, necrotizing enterocolitis, and late-onset sepsis were significantly associated with type 2 severe BPD. Compared with infants with type 1 severe BPD, infants with type 2 severe BPD had an increased risk of mortality (aOR 18.64, 95% CI 10.81-32.13), pulmonary hypertension (aOR 2.16, 95% CI 1.59-2.93), and tracheostomy (aOR 10.38, 95% CI 2.05-52.49). Our data highlight the substantially greater mortality and clinical burden in infants with type 2 severe BPD than infants with type 1 severe BPD. A comprehensive and multidisciplinary approach is needed for infants with type 2 severe BPD.
本研究比较了1型和2型重度支气管肺发育不良（BPD）协作分类的早产儿的基线特征、合并症和临床负担。本研究是一项针对孕周<32周的极低出生体重早产儿的前瞻性队列研究。重度BPD分为1型重度BPD，即月经龄（PMA）36周时需要≥30%氧气和/或无创通气；2型重度BPD，即PMA 36周时需要有创机械通气。比较了这两种类型重度BPD的基线特征、合并症和临床负担。在纳入的1328例婴儿中，983例（74.0%）发生1型重度BPD，345例（26.0%）发生2型重度BPD。较低的出生体重、小于胎龄、母亲胎膜早破程度较轻、5分钟Apgar评分较低、气漏、肺出血、动脉导管未闭手术结扎、坏死性小肠结肠炎和晚发性败血症与2型重度BPD显著相关。与1型重度BPD婴儿相比，2型重度BPD婴儿的死亡风险（调整后比值比[aOR]18.64，95%置信区间[CI]10.81 - 32.13）、肺动脉高压风险（aOR 2.16，95%CI 1.59 - 2.93）和气管切开风险（aOR 10.38，95%CI 2.05 - 52.49）增加。我们的数据突出显示，2型重度BPD婴儿的死亡率和临床负担比1型重度BPD婴儿大得多。对于2型重度BPD婴儿，需要采取全面的多学科方法。
