中国极早早产儿队列中重度支气管肺发育不良的危险因素
Risk factors for severe bronchopulmonary dysplasia in a Chinese cohort of very preterm infants.
作者信息
Huang Jing, Shen Wei, Wu Fan, Mao Jian, Liu Ling, Chang Yanmei, Zhang Rong, Ye Xiuzhen, Qiu Yinping, Ma Li, Cheng Rui, Wu Hui, Chen Dongmei, Chen Ling, Xu Ping, Mei Hua, Wang Sannan, Xu Falin, Ju Rong, Zheng Zhi, Lin Xinzhu, Tong Xiaomei
机构信息
From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
Saudi Med J. 2024 Apr;45(4):369-378. doi: 10.15537/smj.2024.45.4.20230741.
OBJECTIVES
To examine the risk factors for severe bronchopulmonary dysplasia (BPD) in a cohort of very preterm infants (VPIs) in China, as BPD is common among VPIs and associated with a high mortality rate.
METHODS
In this multicenter retrospective study, medical records from infants with BPD born at gestation age (GA) of <32 weeks with birth weight (BW) of <1,500 grams (g) in 7 regions of China were included. The cohort was stratified into different BPD severity groups based on their fraction of inspired oxygen requirement at a modified GA of 36 weeks or post discharge. Risk factors were identified using logistic regression analysis.
RESULTS
A significant inverse correlation was revealed between BPD severity and both GA and BW (<0.001). Independent risk factors for severe BPD (sBPD) were identified as invasive mechanical ventilation (≥7d), multiple blood transfusion (≥3), nosocomial infection (NI), hemodynamically significant patent ductus arteriosus (hsPDA), delayed initiation of enteral nutrition, and longer time to achieve total caloric intake of 110 kcal/kg. Conversely, administration of antenatal steroids was associated with reduced risk of sBPD.
CONCLUSION
Our study not only reaffirmed the established risk factors of low GA and BW for sBPD in VPIs, but also identified additional, potentially modifiable risk factors. Further research is warranted to explore whether intervention in these modifiable factors might reduce the risk of sBPD..
目的
在中国一组极早产儿（VPI）中研究重度支气管肺发育不良（BPD）的危险因素，因为BPD在VPI中很常见且与高死亡率相关。
方法
在这项多中心回顾性研究中，纳入了中国7个地区出生时胎龄（GA）<32周、出生体重（BW）<1500克（g）的BPD婴儿的病历。根据矫正胎龄36周或出院时的吸入氧分数需求，将该队列分为不同的BPD严重程度组。使用逻辑回归分析确定危险因素。
结果
BPD严重程度与GA和BW均呈显著负相关（<0.001）。重度BPD（sBPD）的独立危险因素被确定为有创机械通气（≥7天）、多次输血（≥3次）、医院感染（NI）、血流动力学显著的动脉导管未闭（hsPDA）、肠内营养开始延迟以及达到110千卡/千克总热量摄入的时间更长。相反，产前使用类固醇与sBPD风险降低相关。
结论
我们的研究不仅再次证实了VPI中GA低和BW低是sBPD的既定危险因素，还确定了其他潜在可改变的危险因素。有必要进一步研究探讨对这些可改变因素进行干预是否可能降低sBPD的风险。
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