Wang C H, Chen J J, Ge J J, Ma X L, Shi L P
Department of Neonatal Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
Zhonghua Er Ke Za Zhi. 2022 Jul 2;60(7):682-687. doi: 10.3760/cma.j.cn112140-20211222-01068.
To investigate the risk factors and short-term prognosis of early pulmonary hypertension (PH) in preterm infants. A retrospective case-control study was performed in preterm infants (gestational age <32 weeks) in the neonatal intensive care unit (NICU) of the Children's Hospital, Zhejiang University School of Medicine from January 2012 to December 2019. Eighty preterm infants with a diagnosis of PH between 3 and 14 days (early PH group) were matched in gestational age and sex with the controls (1∶2) of the same period in NICU. Perinatal clinical records, complications, echocardiography and early outcomes were collected. Characteristics and outcomes were compared between the two groups with -test, nonparametric test or Chi-square test. Multivariate Logistic regression was used to analyze the predictive factors of early PH. The gestational age of the early PH group and the control group were both (27.9±1.4) weeks, and 52 (65.0%) and 104 (65.0%) were males in each group, respectively. Univariate analysis showed that birth weights were lower in the early PH group than those in the control group (1 030 (850, 1 200) 1 110 (1 000, 1 278) g, -3.27, 0.001). The early PH group had higher rates of pregnancy-induced hypertension, prolonged rupture of membranes (PROM) >1 week, born by caesarean, small for gestational age (SGA), 1 and 5 min Apgar score ≤7 scores, neonatal respiratory distress syndrome (RDS) and hemodynamic significant patent ductus arteriosus (hsPDA) (12.5% (10/80) 3.8% (6/160), 11.2% (9/80) 3.8% (6/160), 48.8% (39/80) 28.8% (46/160), 10.0% (8/80) 1.9% (3/160), 70.8% (51/72) 51.7% (74/143), 50.0% (36/72) 20.3% (29/143), 88.8% (71/80) 59.4% (95/160), 85.0% (68/80) 22.5% (36/160), χ6.56, 5.12, 3.31, 8.05, 7.17, 20.05, 21.58, 84.84, all <0.05). Multivariate Logistic regression analysis showed that the independent predictive factors of early PH were PROM >1 week, SGA, 5 min Apgar score ≤7 scores, nenonatal RDS and hsPDA (10.40, 18.61, 4.47, 4.13, 20.10, 95% 1.93-56.12, 2.82-122.76, 1.91-10.46, 1.50-11.39, 8.28-48.80, all <0.05),respectively. Infants with early PH had higher incidence of bronchopulmonary dysplasia (BPD), BPD associated PH, severe intraventricular hemorrhage (IVH), extrauterine growth retardation (EUGR), laser treatment for retinopathy of prematurity (ROP) and mortality than the controls (all 0.05). The duration of invasive mechanical ventilation was also longer in the early PH group than that in the control group (0.05). Risk of early PH will be increased in preterm infants with PROM >1 week, SGA, 5 min Apgar score ≤7 scores, and comorbidities of nenonatal RDS and hsPDA. Early PH is associated with increased mortality, BPD, BPD associated PH, severe IVH, EUGR and laser treatment for ROP.
探讨早产儿早期肺动脉高压（PH）的危险因素及短期预后。对浙江大学医学院附属儿童医院新生儿重症监护病房（NICU）2012年1月至2019年12月收治的孕周<32周的早产儿进行回顾性病例对照研究。选取80例出生后3至14天诊断为PH的早产儿（早期PH组），按照孕周和性别与同期NICU的对照组（1∶2）进行匹配。收集围产期临床记录、并发症、超声心动图及早期结局等资料。两组间的特征和结局采用t检验、非参数检验或卡方检验进行比较。采用多因素Logistic回归分析早期PH的预测因素。早期PH组和对照组的孕周均为（27.9±1.4）周，每组男性分别为52例（65.0%）和104例（65.0%）。单因素分析显示，早期PH组出生体重低于对照组（1030（850，1200）g比1110（1000，1278）g，t=-3.27，P=0.001）。早期PH组妊娠期高血压、胎膜早破（PROM）>1周、剖宫产、小于胎龄儿（SGA）、1和5分钟Apgar评分≤7分、新生儿呼吸窘迫综合征（RDS）及血流动力学意义上的动脉导管未闭（hsPDA）的发生率更高（12.5%（10/80）比3.8%（6/160），11.2%（9/80）比3.8%（6/160），48.8%（39/80）比28.8%（46/160），10.0%（8/80）比1.9%（3/160），70.8%（51/72）比51.7%（74/143），50.0%（36/72）比20.3%（29/143），88.8%（71/80）比59.4%（95/160），85.0%（68/80）比22.5%（36/160），χ²值分别为6.56、5.12、3.31、8.05、7.17、20.05、21.58、84.84，均P<0.05）。多因素Logistic回归分析显示，早期PH的独立预测因素为PROM>1周、SGA、5分钟Apgar评分≤7分、新生儿RDS及hsPDA（OR值分别为10.40、18.61、4.47、4.13、20.10，95%CI分别为1.93 - 56.12、2.82 - 122.76、1.91 - 10.46、1.50 - 11.39、8.28 - 48.80，均P<0.05）。早期PH患儿支气管肺发育不良（BPD）、BPD相关PH、重度脑室内出血（IVH）、宫外生长发育迟缓（EUGR）、早产儿视网膜病变（ROP）激光治疗及死亡率高于对照组（均P<0.05）。早期PH组有创机械通气时间也长于对照组（P<0.05）。PROM>1周、SGA、5分钟Apgar评分≤7分及合并新生儿RDS和hsPDA的早产儿发生早期PH的风险增加。早期PH与死亡率、BPD、BPD相关PH、重度IVH、EUGR及ROP激光治疗增加有关。
