You Y, Lyu J W, Zhou L, Wang L P, Zhang J F, Wang L, Zhang Y J, Xia H P
Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200092, China.
Zhonghua Er Ke Za Zhi. 2025 Jan 2;63(1):50-54. doi: 10.3760/cma.j.cn112140-20241010-00705.
To investigate the risk factors associated with post-prematurity respiratory disease (PPRD) in very preterm infants. A prospective cohort study was conducted, enrolling 369 very preterm infants who were admitted to the neonatal intensive care unit of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, within one week of birth from January 2019 to June 2023. Data on maternal and infant clinical characteristics, neonatal morbidities, and treatments during hospitalization were collected. The very preterm infants were divided into 2 groups based on whether they developed PPRD. Continuous variables were compared using Mann-Whitney test, while categorical variables were compared using ² tests or continuity correction test. Multivariate Logistic regression analysis was used to identify the independent risk factors for PPRD in very preterm infants. Among the 369 very preterm infants, 217 cases(58.8%) were male, with a gestational age of 30 (28, 31) weeks at birth and a birth weight of 1 320 (1 085, 1 590) g. Of these, 116 cases (31.4%) developed PPRD, while 253 cases (68.6%) did not. The very preterm infants in the PPRD group had a lower gestational age and lower birth weight (both, <0.001). The PPRD group also had a higher proportion of males, lower Apgar scores at the 1 minute after birth and the 5 minutes after birth, a higher rate of born via cesarean delivery, and a higher incidence of bronchopulmonary dysplasia, more pulmonary surfactant treatment, longer durations of mechanical ventilation, longer total oxygen therapy, and lower Z-score for weight at discharge (all <0.05). Multivariate Logistic regression analysis showed that gestational age (=0.85, 95% 0.73-0.99, =0.037), born via cesarean delivery (=2.23, 95% 1.21-4.10, =0.010), a duration of mechanical ventilation ≥7 days (=2.51, 95% 1.43-4.39, =0.001), and a Z-score for weight at discharge (=0.82, 95% 0.67-0.99, =0.040) were all independent risk factors for PPRD in very preterm infants. Very preterm infants with a small gestational age, born via cesarean section, mechanical ventilation ≥7 days, and a low Z-score for weight at discharge should be closely monitored for PPRD, and provided with standardized respiratory management after discharge.
探讨极早产儿晚期早产相关呼吸系统疾病（PPRD）的危险因素。进行了一项前瞻性队列研究，纳入了2019年1月至2023年6月期间在上海交通大学医学院附属新华医院新生儿重症监护病房出生后1周内入院的369例极早产儿。收集了母婴临床特征、新生儿疾病及住院期间治疗的数据。根据是否发生PPRD将极早产儿分为2组。连续变量采用Mann-Whitney检验进行比较，分类变量采用卡方检验或连续性校正检验进行比较。采用多因素Logistic回归分析确定极早产儿PPRD的独立危险因素。369例极早产儿中，男性217例（58.8%），出生时孕周为30（28，31）周，出生体重为1320（1085，1590）g。其中，116例（31.4%）发生PPRD，253例（68.6%）未发生。PPRD组极早产儿的孕周和出生体重较低（均P<0.001）。PPRD组男性比例较高，出生后1分钟和5分钟时的Apgar评分较低，剖宫产分娩率较高，支气管肺发育不良发生率较高，肺表面活性物质治疗较多，机械通气时间较长，总氧疗时间较长，出院时体重Z评分较低（均P<0.05）。多因素Logistic回归分析显示，孕周（β=0.85，95%CI 0.73-0.99，P=0.037）、剖宫产分娩（β=2.23，95%CI 1.21-4.10，P=0.010）、机械通气时间≥7天（β=2.51，95%CI 1.43-4.39，P=0.001）以及出院时体重Z评分（β=0.82，95%CI 0.67-0.99，P=0.040）均为极早产儿PPRD的独立危险因素。对于孕周小、剖宫产出生、机械通气≥7天且出院时体重Z评分低的极早产儿，应密切监测PPRD，并在出院后提供标准化的呼吸管理。
