Holcik Sophie, Hawayi Lamia, Dussah Naomi, Barrowman Nick, Ben Fadel Nadya, Thébaud Bernard, Katz Sherri Lynne
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Pediatr Pulmonol. 2025 Aug;60(8):e71258. doi: 10.1002/ppul.71258.
Bronchopulmonary dysplasia (BPD), defined as need for oxygen/respiratory support at 36 weeks gestational age (GA) is associated with increased risk of post-prematurity respiratory disease (PRD). We hypothesize that BPD, higher pCO2, and pulmonary hypertension (PH) before NICU discharge will predict PRD.
(1) Identify clinical factors before NICU discharge associated with PRD by 2 years of age; (2) Identify clinical factors associated with emergency room (ER) visits by 2 years of age; (3) Compare predictive performance for PRD of individual and multivariable clinical factors.
Children born < 29 weeks GA with ≥ 1 echocardiogram before NICU discharge at two tertiary centers were included. Retrospective chart review included clinical factors at NICU discharge, ER visits, and respiratory-related hospitalizations by 2 years. Analysis of predictors included logistic regression and ROC.
We included 125 premature infants, of whom 53 (42%) had BPD, and 24 (19%) experienced PRD. All who experienced PRD had BPD. More severe BPD (OR: 96.1, CI: 12.4, 12, 383), but not hypercapnia or PH, were associated with PRD. On ROC analysis, combination of BPD severity, pCO2 and PH demonstrated 70% chance of PRD (AUC: 0.68 (95% CI: 0.55, 0.81). Presence of ≥ 2 factors had sensitivity of 50% and specificity of 97% for prediction of PRD. Children with BPD had 2.6 times as many ER visits as those without.
Combination of BPD severity, pCO2, and PH best predicted PRD. Identifying extremely preterm infants at high risk of developing PRD can guide counseling of families and early intervention.
支气管肺发育不良（BPD）定义为孕36周胎龄（GA）时仍需要氧气/呼吸支持，与早产后期呼吸系统疾病（PRD）风险增加相关。我们假设在新生儿重症监护病房（NICU）出院前的BPD、较高的二氧化碳分压（pCO2）和肺动脉高压（PH）将可预测PRD。
（1）确定NICU出院前与2岁时PRD相关的临床因素；（2）确定与2岁时急诊室（ER）就诊相关的临床因素；（3）比较个体和多变量临床因素对PRD的预测性能。
纳入在两个三级中心NICU出院前胎龄<29周且有≥1次超声心动图检查的儿童。回顾性病历审查包括NICU出院时的临床因素、ER就诊情况以及2岁时与呼吸相关的住院情况。预测因素分析包括逻辑回归和ROC曲线分析。
我们纳入了125名早产儿，其中53名（42%）患有BPD，24名（19%）发生了PRD。所有发生PRD的患儿均患有BPD。更严重的BPD（比值比：96.1，可信区间：12.4，12，383）而非高碳酸血症或PH与PRD相关。在ROC分析中，BPD严重程度、pCO2和PH的组合显示发生PRD的概率为70%（曲线下面积：0.68（95%可信区间：0.55，0.81）。存在≥2个因素对PRD预测的敏感性为50%，特异性为97%。患有BPD的儿童ER就诊次数是未患BPD儿童的2.6倍。
BPD严重程度、pCO2和PH的组合对PRD的预测效果最佳。识别出有发生PRD高风险的极早产儿可为家庭咨询和早期干预提供指导。
