Neonatal-Perinatal Medicine Division, Children's Hospital of Orange County, Orange, California, USA.
Children's Hospital Association, Lenexa, Kansas, USA.
Pediatr Pulmonol. 2022 Sep;57(9):2082-2091. doi: 10.1002/ppul.25983. Epub 2022 May 25.
To describe characteristics, outcomes, and risk factors for death or tracheostomy with home mechanical ventilation in full-term infants with chronic lung disease (CLD) admitted to regional neonatal intensive care units.
This was a multicenter, retrospective cohort study of infants born ≥37 weeks of gestation in the Children's Hospitals Neonatal Consortium.
Out of 67,367 full-term infants admitted in 2010-2016, 4886 (7%) had CLD based on receiving respiratory support at either 28 days of life or discharge. 3286 (67%) were still hospitalized at 28 days receiving respiratory support, with higher mortality risk than those without CLD (10% vs. 2%, p < 0.001). A higher proportion received tracheostomy (13% vs. 0.3% vs. 0.4%, p < 0.001) and gastrostomy (30% vs. 1.7% vs. 3.7%, p < 0.001) compared to infants with CLD discharged home before 28 days and infants without CLD, respectively. The diagnoses and surgical procedures differed significantly between the two CLD subgroups. Small for gestational age, congenital pulmonary, airway, and cardiac anomalies and bloodstream infections were more common among infants with CLD who died or required tracheostomy with home ventilation (p < 0.001). Invasive ventilation at 28 days was independently associated with death or tracheostomy and home mechanical ventilation (odds ratio 7.6, 95% confidence interval 5.9-9.6, p < 0.0001).
Full-term infants with CLD are at increased risk for morbidity and mortality. We propose a severity-based classification for CLD in full-term infants. Future work to validate this classification and its association with early childhood outcomes is necessary.
描述在接受区域新生儿重症监护病房治疗的足月慢性肺疾病（CLD）婴儿中，进行家庭机械通气的死亡或气管切开的特征、结局和危险因素。
这是一项多中心、回顾性队列研究，研究对象为 2010 年至 2016 年在儿童医院新生儿联盟出生的胎龄≥37 周的婴儿。
在 2010 年至 2016 年期间，67367 名足月婴儿中，有 4886 名（7%）因在 28 天的生命或出院时接受呼吸支持而患有 CLD。3286 名（67%）在 28 天仍住院接受呼吸支持，其死亡率高于无 CLD 的婴儿（10%比 2%，p<0.001）。与在 28 天前出院回家的 CLD 婴儿和无 CLD 的婴儿相比，接受气管切开术（13%比 0.3%比 0.4%，p<0.001）和胃造口术（30%比 1.7%比 3.7%，p<0.001）的比例更高。与在家接受机械通气的 CLD 婴儿相比，患有 CLD 且死亡或需要气管切开的婴儿的诊断和手术程序存在显著差异。小于胎龄儿、先天性肺、气道和心脏异常以及血流感染在 CLD 死亡或需要气管切开术并进行家庭通气的婴儿中更为常见（p<0.001）。28 天时的有创通气与死亡或气管切开术和家庭机械通气独立相关（比值比 7.6，95%置信区间 5.9-9.6，p<0.0001）。
患有 CLD 的足月婴儿存在较高的发病率和死亡率。我们提出了一种基于严重程度的足月 CLD 分类。需要进一步的工作来验证这种分类及其与幼儿期结局的关联。
