Hirata Katsuya, Nakanishi Hidehiko, Namba Fumihiko, Mochizuki Narutaka, Hirano Shinya, Wada Kazuko, Fujimura Masanori
Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.
Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Pediatr Neonatol. 2025 Jun 20. doi: 10.1016/j.pedneo.2025.05.005.
Advances in neonatal care have considerably improved the survival rates of extremely preterm infants. However, long-term pulmonary sequelae remain a major concern. A revised classification of bronchopulmonary dysplasia (BPD) in Japan highlights histological chorioamnionitis, small for gestational age (SGA), and a bubbly/cystic appearance on chest X-ray (bubbly/cystic CXR) as key risk factors. This study aimed to evaluate the effect of extremely preterm birth on lung function at school age.
This retrospective study included 283 extremely preterm infants (born at <28 weeks of gestation) admitted to our institution between 1994 and 2013. Perinatal data and spirometry results obtained at 8 years of age were analyzed. Logistic regression analysis was performed to assess the association of histological chorioamnionitis, SGA, and bubbly/cystic CXR with obstructive (FEV [forced expiratory volume in 1 s]/FVC [forced vital capacity] < LLN [lower limit of normal]), restrictive (FEV/FVC ≥ LLN and FVC < LLN), and mixed (FEV/FVC < LLN and FVC < LLN) patterns, with adjustments for gestational age, sex, and birth year.
Extremely preterm infants exhibited lower z-scores for FEV/FVC, FEV, and FVC than the predicted values based on age, height, and sex. Bubbly/cystic CXR findings was associated with an increased risk of obstructive (adjusted odds ratio [aOR], 2.30; 95 % confidence interval [CI], 1.12-4.72) and mixed patterns (aOR, 3.51; 95 % CI, 1.19-10.4). SGA was a risk factor for a restrictive pattern (aOR, 2.81; 95 % CI, 1.37-5.74).
Bubbly/cystic CXR findings and SGA status, key components of the revised Japanese BPD classification, were significantly associated with long-term pulmonary function abnormalities in extremely preterm infants, characterized predominantly by obstructive/mixed and restrictive patterns, respectively. These findings highlight the importance of targeted strategies to address specific perinatal risk factors and improve long-term pulmonary outcomes in this high-risk population.
新生儿护理的进展显著提高了极早产儿的存活率。然而，长期肺部后遗症仍然是一个主要问题。日本修订的支气管肺发育不良（BPD）分类强调组织学绒毛膜羊膜炎、小于胎龄儿（SGA）以及胸部X线片上的气泡状/囊性表现（气泡状/囊性CXR）是关键危险因素。本研究旨在评估极早产对学龄期肺功能的影响。
这项回顾性研究纳入了1994年至2013年间入住我院的283例极早产儿（孕周<28周）。分析围产期数据和8岁时的肺功能测定结果。进行逻辑回归分析，以评估组织学绒毛膜羊膜炎、SGA和气泡状/囊性CXR与阻塞性（第1秒用力呼气容积[FEV]/用力肺活量[FVC]<正常下限[LLN]）、限制性（FEV/FVC≥LLN且FVC<LLN）和混合性（FEV/FVC<LLN且FVC<LLN）模式之间的关联，并对孕周、性别和出生年份进行调整。
极早产儿的FEV/FVC、FEV和FVC的z评分低于根据年龄、身高和性别预测的值。气泡状/囊性CXR表现与阻塞性模式（调整后的优势比[aOR]，2.30；95%置信区间[CI]，1.12 - 4.72）和混合性模式（aOR，3.51；95%CI，1.19 - 10.4）风险增加相关。SGA是限制性模式的一个危险因素（aOR，2.81；95%CI，1.37 - 5.74）。
气泡状/囊性CXR表现和SGA状态是日本修订的BPD分类的关键组成部分，分别与极早产儿长期肺部功能异常显著相关，主要表现为阻塞性/混合性和限制性模式。这些发现凸显了针对特定围产期危险因素采取针对性策略以及改善这一高危人群长期肺部结局的重要性。
