Menshykova Anna O, Dobryanskyy Dmytro O
Department of Pediatrics No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
J Matern Fetal Neonatal Med. 2025 Dec;38(1):2501697. doi: 10.1080/14767058.2025.2501697. Epub 2025 May 13.
Bronchopulmonary dysplasia (BPD) remains a common pathology in very preterm infants. The risk of complications increases with the severity of the disease.The study aimed to determine the factors affecting the formation of moderate/severe BPD in the modern population of very preterm infants.
Data from 201 very low birth weight infants < 32 weeks of gestation were used in a retrospective cohort study. Infants were retrospectively divided into two groups based on the type of respiratory support at 36 weeks of postmenstrual age (PMA) - mild BPD (133 infants) and moderate/severe BPD (68 infants). The influence of major perinatal risk factors, neonatal morbidity, and medical interventions on the development of moderate/severe BPD was assessed.
The groups were different in the incidence of intrauterine growth restriction (5% vs. 15%; = 0.02), maternal hypertension (5% vs. 18%; = 0.004), cesarean section (29% vs. 43%; = 0.04), severe intraventricular hemorrhage (9% vs. 19%; = 0.04), and retinopathy of prematurity (5% vs. 18%; = 0.002), as well as in need for chest compressions during resuscitation at birth (2% vs. 9%; = 0.01) for mild and moderate/severe BPD, respectively. Infants in the moderate/severe BPD group had lower Apgar scores at 1 and 5 min, required longer mechanical ventilation (220 (10-1904) hours vs. 72 (1-614) hours; < 0.0001), CPAP duration (456 (16-1320) hours vs. 278 (10-1200) hours; = 0.0002), oxygen supply (50 (3-146) days vs. 29 (2-68) days; < 0.0001), as well as antibacterial therapy (61 (16-177) days vs. 52 (9-121) days; = 0.0001) and hospital stay (109 (59-321) days vs. 85 (45-205) days; < 0.0001). Infants with more severe BPD were also significantly more likely to die after reaching the PMA of 36 weeks (12% vs. 1%; = 0.0003).According to the multivariable logistic regression analysis, the moderate/severe BPD was reliably and independently determined by maternal hypertension (aOR 4.53, 95% CI 1.48-13.91) and genitourinary infections (aOR 4.41, 95% CI 1.41-13.78), as well as the duration of CPAP (aOR 1.002, 95% CI 1.001-1.004) and mechanical ventilation (aOR 1.006, 95% CI 1.004-1.009).
Duration of respiratory support is the main risk factor that determines the development of moderate/severe BPD in the modern population of very preterm infants. Maternal hypertension and genitourinary infections may influence the severity of lung injury.
支气管肺发育不良（BPD）仍是极早产儿常见的病理状况。疾病并发症风险随病情严重程度增加。本研究旨在确定影响现代极早产儿中重度BPD形成的因素。
回顾性队列研究使用了201例孕周<32周的极低出生体重儿的数据。根据孕龄36周时的呼吸支持类型将婴儿回顾性分为两组——轻度BPD（133例婴儿）和中重度BPD（68例婴儿）。评估了主要围产期危险因素、新生儿发病率和医疗干预对中重度BPD发生发展的影响。
两组在以下方面存在差异：宫内生长受限发生率（5%对15%；P = 0.02）、母亲高血压（5%对18%；P = 0.004）、剖宫产（29%对43%；P = 0.04）、重度脑室内出血（9%对19%；P = 0.04）、早产儿视网膜病变（5%对18%；P = 0.002），以及出生复苏时需要胸外按压的情况（轻度和中重度BPD分别为2%对9%；P = 0.01）。中重度BPD组婴儿在1分钟和5分钟时的阿氏评分较低，需要更长时间的机械通气（220（10 - 1904）小时对72（1 - 614）小时；P < 0.0001）、持续气道正压通气（CPAP）时间（456（16 - 13_{2}0）小时对278（10 - 1200）小时；P = 0.0002）、吸氧时间（50（3 - 146）天对29（2 - 68）天；P < 0.0001），以及抗菌治疗时间（61（16 - 177）天对52（9 - 121）天；P = 0.0001）和住院时间（109（59 - 321）天对85（45 - 205）天；P < 0.0001）。病情更严重的BPD婴儿在达到孕龄36周后死亡的可能性也显著更高（12%对1%；P = 0.0003）。根据多变量逻辑回归分析，母亲高血压（调整后比值比[aOR]4.53，95%置信区间[CI]1.48 - 13.91）、泌尿生殖系统感染（aOR 4.41，95% CI 1.41 - 13.78），以及CPAP持续时间（aOR 1.002，95% CI 1.001 - 1.004）和机械通气时间（aOR 1.006，95% CI 1.004 - 1.009）可可靠且独立地判定中重度BPD。
呼吸支持时间是决定现代极早产儿中重度BPD发生发展的主要危险因素。母亲高血压和泌尿生殖系统感染可能影响肺损伤的严重程度。
