Hammond J D, Kielt Matthew J, Conroy Sara, Lingappan Krithika, Austin Eric D, Eldredge Laurie C, Truog William E, Abman Steven H, Nelin Leif D, Guaman Milenka Cuevas
Texas Children's Hospital, Houston, TX.
Nationwide Children's Hospital, Columbus, OH.
Chest. 2024 Mar;165(3):610-620. doi: 10.1016/j.chest.2023.10.020. Epub 2023 Oct 24.
Bronchopulmonary dysplasia (BPD) is a significant contributor to morbidity and death in infants who are born premature. Male sex is an independent risk factor for the development of BPD. However, whether male sex is associated with adverse outcomes that occur after formal diagnosis of severe BPD prior to hospital discharge remains unclear.
Is male sex associated with a higher risk of adverse outcomes in infants with established severe BPD?
A retrospective, multicenter cohort study of infants enrolled in the BPD Collaborative Registry from January 1, 2015, to June 29, 2022, was performed. Demographics, clinical characteristics, and outcomes were stratified by sex (ie, male vs female). Regression modeling was used to estimate the association of sex with the primary composite outcome of death or tracheostomy at hospital discharge.
We identified 1,156 infants with severe BPD, defined at 36 weeks postmenstrual age by the National Institutes of Health 2001 consensus definition. The cohort was predominantly male (59% male infants, 41% female infants). However, rates of mechanical ventilation at 36 weeks postmenstrual age (ie, type 2 severe BPD) did not differ by sex. Overall mortality rates within the cohort were low (male infants, 5.3%; female infants, 3.6%). The OR of death or tracheostomy for male-to-female infants was 1.0 (95% CI, 0.7-1.5).
Our results lead us to speculate that, although sex is an important variable that contributes to the development and pathogenesis of severe BPD, it does not appear to be associated with adverse outcomes in this cohort of infants with established disease. The surprising results raise important questions surrounding the temporal role of biological sex in the development of severe BPD and its progression during the neonatal ICU stay. As we explore the phenotypes and endotypes of BPD, it is imperative to consider how sex modulates the disease from birth through hospital discharge.
支气管肺发育不良（BPD）是早产婴儿发病和死亡的重要原因。男性是BPD发生的独立危险因素。然而，男性是否与出院前确诊为重度BPD后的不良结局相关尚不清楚。
男性是否与已确诊的重度BPD婴儿发生不良结局的风险较高相关？
对2015年1月1日至2022年6月29日纳入BPD协作登记处的婴儿进行了一项回顾性、多中心队列研究。人口统计学、临床特征和结局按性别（即男性与女性）分层。回归模型用于估计性别与出院时死亡或气管造口术的主要复合结局之间的关联。
我们确定了1156例重度BPD婴儿，根据美国国立卫生研究院2001年的共识定义，在孕龄36周时确诊。该队列中男性占主导（59%为男婴，41%为女婴）。然而，孕龄36周时的机械通气率（即2型重度BPD）在性别上没有差异。该队列中的总体死亡率较低（男婴为5.3%；女婴为3.6%）。男婴与女婴死亡或气管造口术的比值比为1.0（95%CI，0.7 - 1.5）。
我们的结果使我们推测，尽管性别是导致重度BPD发生和发病机制的一个重要变量，但在这一已确诊疾病的婴儿队列中，它似乎与不良结局无关。这些令人惊讶的结果引发了围绕生物学性别在重度BPD发生及其在新生儿重症监护病房住院期间进展中的时间作用的重要问题。在我们探索BPD的表型和内型时，必须考虑性别如何从出生到出院调节该疾病。
