Division of Neonatology, Department of Pediatrics, Stanford University, Stanford, CA; California Perinatal Quality Care Collaborative, Stanford, CA; Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Division of Neonatology, Department of Pediatrics, Stanford University, Stanford, CA; California Perinatal Quality Care Collaborative, Stanford, CA.
J Pediatr. 2022 Apr;243:47-52.e2. doi: 10.1016/j.jpeds.2021.11.049. Epub 2021 Nov 25.
To characterize the incidence of bronchopulmonary dysplasia (BPD) over time and to test the association of multilevel factors, including respiratory support, with the diagnosis of BPD.
This population-based cohort study included 40 268 infants born between 22 and 32 weeks of gestation at hospitals in California between 2008 and 2017. The diagnosis of BPD was based on respiratory support at 36 weeks postmenstrual age. Tests for linear trend and multivariable logistic regression analyses were performed.
The rate of BPD was consistent year to year, and the mortality rate declined. The incidence of BPD was 23.5% for the overall cohort, 44.9% for infants born at <28 weeks of gestational age, and 45.2% for extremely low birth weight infants. For infants born at >26 weeks of gestational age, the incidence of BPD was significantly decreased in the most recent 3-year period compared with the earlier 3 years (OR, 0.91). Invasive ventilation during delivery room resuscitation (OR, 2.64) and after leaving the delivery room (OR, 10.02) conferred the highest risk of BPD compared with oxygen or no respiratory support. Noninvasive ventilation as maximum respiratory support at 36 weeks increased by 20% over time.
Marked changes in noninvasive support care have occurred without an overall decline in BPD rate. Further research, quality improvement, and strategies, along with noninvasive respiratory support, are needed for a reduction in the incidence of BPD.
描述支气管肺发育不良（BPD）随时间的发生率，并检验呼吸支持等多水平因素与 BPD 诊断的相关性。
这项基于人群的队列研究纳入了 2008 年至 2017 年期间加利福尼亚州多家医院出生、胎龄 22-32 周的 40268 例婴儿。BPD 的诊断依据为校正胎龄 36 周时的呼吸支持。进行线性趋势检验和多变量逻辑回归分析。
BPD 的发生率保持稳定，死亡率下降。全队列的 BPD 发生率为 23.5%，胎龄<28 周的婴儿发生率为 44.9%，极低出生体重儿发生率为 45.2%。对于胎龄>26 周的婴儿，最近 3 年 BPD 的发生率明显低于前 3 年（比值比，0.91）。与氧疗或无呼吸支持相比，产房复苏时的有创通气（比值比，2.64）和离开产房后的有创通气（比值比，10.02）导致 BPD 的风险最高。36 周时，作为最大呼吸支持的无创通气的使用比例随时间增加了 20%。
尽管 BPD 的发生率没有总体下降，但无创支持治疗方式发生了显著变化。需要进一步研究、质量改进和策略，以及无创呼吸支持，以降低 BPD 的发生率。
