呼吸支持模式的变化与支气管肺发育不良的发生率；单中心经验。
Changes in the patterns of respiratory support and incidence of bronchopulmonary dysplasia; a single center experience.
机构信息
Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
出版信息
BMC Pediatr. 2023 Jul 13;23(1):357. doi: 10.1186/s12887-023-04176-x.
BACKGROUND
With the advances in neonatal intensive care, the survival rate of extremely preterm infants is increasing. However, bronchopulmonary dysplasia (BPD) remains a major cause of morbidity among infants in this group. This study examined the changes in respiratory support modalities, specifically heated humidified high-flow nasal cannula (HHHFNC), and their association with BPD incidence among preterm infants born at < 29 weeks of gestation.
METHOD
This population-based retrospective cohort study included infants born at < 29 weeks of gestation between 2016 and 2020. Data regarding the use and duration of respiratory support modalities were obtained, including mechanical ventilation, continuous positive airway pressure, HHHFNC, and low-flow oxygen therapy. Additionally, the incidence of BPD was determined in the included infants. Trend analysis for each respiratory support modality and BPD incidence rate was performed to define the temporal changes associated with changes in BPD rates. In addition, a logistic regression model was developed to identify the association between BPD and severity grade using HHHFNC.
RESULTS
Three Hundred and sixteen infants were included in this study. The use and duration of HHHFNC therapy increased during the study period. Throughout the study period, the overall incidence of BPD was 49%, with no significant trends. The BPD rate was significantly higher in the infants who received HHHFNC than in those who did not (52% vs. 39%, P = 0.03). Analysis of BPD severity grades showed that both grade 1 BPD (34% vs. 21%, P = 0.03) and grade 2 BPD (12% vs. 1%, P < 0.01) were significantly more common among infants who received HHHFNC than among those who did not. In contrast, the incidence of grade 3 BPD was lower in infants who received HHFNC (6% vs. 17%, P < 0.01). The duration in days of HHHFNC was found to significantly predict BPD incidence (OR 1.04 [95%CI: 1.01-1.06], P < 0.01) after adjusting for confounding variables.
CONCLUSION
The use of HHHFNC in extremely preterm infants born at < 29 weeks of gestation is increasing. There was a significant association between the duration of HHHFNC therapy and the development of BPD in extremely preterm infants born at < 29 weeks of gestation.
背景
随着新生儿重症监护技术的进步，极早产儿的存活率正在提高。然而，支气管肺发育不良（BPD）仍然是该类婴儿发病的主要原因。本研究探讨了呼吸支持方式的变化，特别是加热湿化高流量鼻导管（HHHFNC），及其与 <29 孕周出生的早产儿 BPD 发生率的关系。
方法
这是一项基于人群的回顾性队列研究，纳入了 2016 年至 2020 年期间出生的 <29 孕周的早产儿。获得了呼吸支持方式（包括机械通气、持续气道正压通气、HHHFNC 和低流量氧疗）的使用和持续时间的数据，并确定了纳入婴儿的 BPD 发生率。对每种呼吸支持方式和 BPD 发生率进行趋势分析，以确定与 BPD 发生率变化相关的时间变化。此外，还使用 HHHFNC 建立了一个逻辑回归模型来确定 BPD 与严重程度等级之间的关系。
结果
本研究纳入了 316 名婴儿。HHHFNC 治疗的使用和持续时间在研究期间增加。在整个研究期间，BPD 的总发生率为 49%，无显著趋势。接受 HHHFNC 治疗的婴儿的 BPD 发生率明显高于未接受 HHHFNC 治疗的婴儿（52% vs. 39%，P=0.03）。BPD 严重程度分级分析显示，接受 HHHFNC 治疗的婴儿中，1 级 BPD（34% vs. 21%，P=0.03）和 2 级 BPD（12% vs. 1%，P<0.01）的发生率显著高于未接受 HHHFNC 治疗的婴儿。相反，接受 HHFNC 治疗的婴儿中 3 级 BPD 的发生率较低（6% vs. 17%，P<0.01）。在调整了混杂变量后，HHHFNC 的使用天数与极早产儿 <29 孕周的 BPD 发生率显著相关（OR 1.04 [95%CI：1.01-1.06]，P<0.01）。
结论
在 <29 孕周出生的极早产儿中，HHHFNC 的使用正在增加。HHHFNC 治疗时间与 <29 孕周出生的极早产儿 BPD 的发生有显著相关性。
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