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台湾某医学中心对支气管肺发育不良早产儿家庭氧疗的特征及两年神经发育结局的回顾性研究

The Characteristics and Two-Year Neurodevelopmental Outcomes of Home Oxygen Therapy among Preterm Infants with Bronchopulmonary Dysplasia: A Retrospective Study in a Medical Center in Taiwan.

作者信息

Chang Han-Pi, Lee En-Pei, Chiang Ming-Chou

机构信息

Division of Pediatric Emergency, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.

College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.

出版信息

Biomedicines. 2024 Jul 15;12(7):1564. doi: 10.3390/biomedicines12071564.

Abstract

Home oxygen therapy (HOT) is frequently used as a therapeutic strategy for children experiencing chronic oxygen dependency associated with bronchopulmonary dysplasia (BPD). Recent studies have highlighted substantial variations in the characteristics and outcomes of infants requiring oxygen, primarily due to the absence of a consensus on the management of HOT in infants with BPD. We conducted this retrospective study and reviewed the medical records of extremely and very preterm infants who were diagnosed with BPD in a tertiary center in northern Taiwan from January 2020 to September 2021. Their neurodevelopmental outcomes were evaluated at 18 to 24 months of corrected age. A total of 134 patients diagnosed with BPD were divided into a HOT group ( = 39) and a room air group ( = 95). The children in the HOT group had a higher incidence of hemodynamic significant patent ductus arteriosus (PDA) ( = 0.005) and PDA ligation ( = 0.004), high-frequency oscillatory ventilation ( < 0.001), nitrogen oxide inhalation ( < 0.001), pulmonary hypertension ( = 0.01), and longer invasive ventilation ( < 0.001), as well as longer hospitalization ( < 0.001). A multivariate logistic regression model demonstrated that prolonged invasive ventilation (OR = 1.032, 95% CI 0.984-1.020, = 0.001) was correlated with oxygen dependency in children. Infants with BPD born at advanced gestational age (OR = 0.760, 95%CI 0.582-0.992, = 0.044) had a decreasing risk of requiring HOT. The children in the HOT group had a higher incidence of emergency room visits ( < 0.001) and re-hospitalization ( = 0.007) within one year of corrected age. The neurodevelopmental outcomes revealed the HOT group had an increasing portion of moderate to severe cognitive delay (18.2% vs. 3.7%, = 0.009) and moderate to severe language delay (24.2% vs. 6.1%, = 0.006) at 18 to 24 months of corrected age. In conclusion, infants with BPD necessitating HOT required prolonged invasive ventilation during hospitalization and exhibited a greater prevalence of unfavorable neurodevelopmental outcomes at 18 to 24 months of corrected age as well.

摘要

家庭氧疗(HOT)常被用作治疗患有与支气管肺发育不良(BPD)相关的慢性氧依赖的儿童的一种治疗策略。最近的研究强调了需要吸氧的婴儿在特征和结局方面存在很大差异,主要是因为对于患有BPD的婴儿的家庭氧疗管理缺乏共识。我们进行了这项回顾性研究,并回顾了2020年1月至2021年9月在台湾北部一家三级中心被诊断为BPD的极早产儿和超早产儿的病历。在矫正年龄18至24个月时评估他们的神经发育结局。总共134例被诊断为BPD的患者被分为家庭氧疗组(n = 39)和室内空气组(n = 95)。家庭氧疗组的儿童血流动力学显著的动脉导管未闭(PDA)发生率更高(P = 0.005)、PDA结扎率更高(P = 0.004)、高频振荡通气发生率更高(P < 0.001)、一氧化氮吸入发生率更高(P < 0.001)、肺动脉高压发生率更高(P = 0.01)、有创通气时间更长(P < 0.001)以及住院时间更长(P < 0.001)。多因素逻辑回归模型表明,延长有创通气时间(OR = 1.032,95%CI 0.984 - 1.020,P = 0.001)与儿童的氧依赖相关。孕龄较大的患有BPD的婴儿(OR = 0.760,95%CI 0.582 - 0.992,P = 0.044)需要家庭氧疗的风险降低。家庭氧疗组的儿童在矫正年龄1年内急诊就诊发生率更高(P < 0.001)和再次住院率更高(P = 0.007)。神经发育结局显示,家庭氧疗组在矫正年龄18至24个月时中度至重度认知延迟的比例增加(18.2%对3.7%,P = 0.009),中度至重度语言延迟的比例增加(24.2%对6.1%,P = 0.006)。总之,需要家庭氧疗的患有BPD的婴儿在住院期间需要延长有创通气时间,并且在矫正年龄18至24个月时不良神经发育结局的患病率也更高。

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Semin Fetal Neonatal Med. 2020 Apr;25(2):101082. doi: 10.1016/j.siny.2020.101082. Epub 2020 Jan 24.

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