van Westering-Kroon Elke, Hundscheid Tamara M, Van Mechelen Karen, Bartoš František, Abman Steven H, Villamor Eduardo
Division of Neonatology, MosaKids Children's Hospital, Maastricht University Medical Centre (MUMC + ), Research Institute for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands.
Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
Pediatr Res. 2025 May 27. doi: 10.1038/s41390-025-04145-3.
Bronchopulmonary dysplasia (BPD) is generally considered to be more frequent in males than in females. We conducted a Bayesian model-averaged (BMA) meta-analysis of studies addressing sex differences in the risk of developing different severities of BPD and BPD-associated pulmonary hypertension (BPD-PH).
We used BMA to calculate Bayes factors (BFs). The BF is the ratio of the probability of the data under the alternative hypothesis (presence of sex differences) over the probability of the data under the null hypothesis (absence of sex differences). BPD was classified as BPD28 (Supplementary oxygen at or during 28 days), BPD36 (moderate-to-severe BPD; oxygen at 36 weeks postmenstrual age), mild, moderate, and severe BPD.
We included 222 studies (541,826 infants). The BMA analysis showed evidence in favor of a male disadvantage in BPD28 (BF > 10), BPD36 (BF > 10), and severe BPD (BF = 87.55), but not in mild BPD (BF = 0.28), or BPD-PH (BF = 0.54). The evidence for a male disadvantage in BPD decreased as the gestational age of the cohort decreased.
We confirmed the presence of a male disadvantage in moderate-to-severe BPD, but not in less severe forms of BPD or in BPD-PH. The male disadvantage in BPD is much less apparent in the more immature infants.
This Bayesian meta-analysis confirms that the risk of developing moderate to severe bronchopulmonary dysplasia (BPD) is approximately 20% higher in males than in females. Sex differences in BPD decrease with decreasing gestational age, are heterogeneous across geographic and sociodemographic settings, and have remained persistently stable over time. There is no evidence supporting sex differences in pulmonary hypertension associated with BPD. An important step in the process of individualizing the approach to BPD may be to consider the sex of the infant, as this information can be used to personalize care and potentially improve outcomes.
支气管肺发育不良（BPD）通常被认为在男性中比在女性中更常见。我们对研究BPD不同严重程度及BPD相关肺动脉高压（BPD-PH）发生风险的性别差异的研究进行了贝叶斯模型平均（BMA）荟萃分析。
我们使用BMA计算贝叶斯因子（BFs）。BF是备择假设（存在性别差异）下数据的概率与原假设（不存在性别差异）下数据的概率之比。BPD分为BPD28（出生28天或28天内需要吸氧）、BPD36（中重度BPD；月经龄36周时需要吸氧）、轻度、中度和重度BPD。
我们纳入了222项研究（541,826名婴儿）。BMA分析显示，有证据支持男性在BPD28（BF > 10）、BPD36（BF > 10）和重度BPD（BF = 87.55）方面处于劣势，但在轻度BPD（BF = 0.28）或BPD-PH（BF = 0.54）方面并非如此。随着队列胎龄的降低，男性在BPD方面处于劣势的证据减少。
我们证实了在中重度BPD中存在男性劣势，但在较轻程度的BPD或BPD-PH中不存在。在更不成熟的婴儿中，男性在BPD方面的劣势不太明显。
这项贝叶斯荟萃分析证实，男性发生中重度支气管肺发育不良（BPD）的风险比女性高约20%。BPD中的性别差异随着胎龄的降低而减小，在不同地理和社会人口背景下具有异质性，并且随着时间的推移一直保持稳定。没有证据支持与BPD相关的肺动脉高压存在性别差异。在BPD个体化治疗过程中的一个重要步骤可能是考虑婴儿的性别，因为这些信息可用于个性化护理并可能改善结局。
