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Title: [Clinical characteristics and risk factors of very low birth weight and extremely low birth weight infants with bronchopulmonary dysplasia: multicenter retrospective analysis].
Author: Jiangsu Multicenter Study Collaborative Group for Breastmilk Feeding in Neonatal Intensive Care Units.
Journal: Zhonghua Er Ke Za Zhi; 2019 Jan 02; 57(1):33-39. PubMed ID: 30630229.
Abstract:
Objective: To analyze clinical characteristics and risk factors of very low birth weight and extremely low birth weight infants with bronchopulmonary dysplasia (BPD). Methods: A retrospective epidemiological study was performed in 768 neonates (376 males) with birth weights<1 500 g and gestational age ≤ 34 weeks who survived ≥28 days. Clinical data were obtained from the multi-center clinical database of neonatal intensive care units (NICU) in 19 hospitals of Jiangsu Province between January 1, 2017 and December 31, 2017. These infants were divided into non-BPD group and BPD group according to BPD diagnositic criteria. Clinical features and potential risk factors were compared between groups with Chi-square test or nonparametric test. Risk factors for BPD were analyzed with Logistic regression analysis. Results: Among the total of 768 eligible neonates, 577 without BPD, 191 with BPD (24.9%). Mild, moderate and severe BPD accounted for 73.3% (140/191), 23.6% (45/191) and 3.1% (6/191) of all BPD cases respectively. There were significant differences in the average gestational age (29 (28, 30) vs. 30 (29, 31) weeks) or the average birth weight (1 170 (990, 1 300) vs. 1 300 (1 160, 1 400) g) between BPD group and non-BPD group (Z=-9.959,-7.202, both P=0.000). The incidences of BPD in the infants with gestational age of<28 weeks, 28-31 weeks and 32-34 weeks were 51.7% (46/89), 24.8% (139/561), 5.1% (6/118) respectively. The incidences of BPD in infants with birth weight<1 000 g, 1 000- 1 249 g and 1 250-1 500 g were 62.3% (48/77), 25.9% (70/270) and 17.3% (73/421) respectively. Proportion of male (55.5% (106/191) vs. 46.8% (270/577)), rate and length of conventional mechanical ventilation (48.7% (93/191) vs. 14.9% (86/577), 120 (72, 259) vs. 80 (29, 144)h), initial inhaled oxygen concentration and maximum inhaled oxygen concentration (0.35 (0.30, 0.40) vs. 0.30(0.25, 0.40), 0.40 (0.30, 0.50) vs. 0.30 (0.30, 0.40)) and volume of red blood cell transfusion (53(30, 90) vs.38(28, 55) ml) were higher in BPD group than in non-BPD group (χ(2)=4.350, 91.640, Z=-3.557, -2.848, -3.776, -4.677, all P<0.05). Rate of continuous positive airway pressure (12.6%(24/191) vs. 19.4%(112/577)) during neonatal resuscitation in delivery room was lower in BPD group than that in non-BPD group (χ(2)=4.614, P=0.032). The incidences of complications in BPD group including severe asphyxia, neonatal respiratory distress syndrome (NRDS), persistent pulmonary hypertension in newborns (PPHN), patent ductus arteriosus, anemia of prematurity, early onset sepsis, clinical sepsis and ventilator associated pneumonia were higher than that in non-BPD group (15.2%(29/191) vs. 4.5% (26/577), 91.1% (174/191) vs. 56.7% (327/577), 2.6% (5/191) vs. 0.2% (1/577), 43.5% (83/191) vs. 34.2% (197/577), 88.0% (168/191) vs. 58.8% (339/577), 15.7% (30/191) vs. 9.9% (57/577), 42.9% (82/191) vs. 18.6% (107/577), 14.1% (27/191) vs. 2.3% (13/577); χ(2)=24.605, 74.993, 9.167, 5.373, 61.866, 4.557, 43.149, 34.315, all P<0.05). Multivariate logistic regression analysis showed that NRDS (OR=4.651, 95%CI: 1.860-11.625), clinical sepsis (OR=1.989, 95%CI: 1.067-3.708), ventilator associated pneumonia (OR=3.155, 95%CI: 1.060-9.388), conventional mechanical ventilation (OR=2.298, 95%CI: 1.152-4.586), and volume of red blood cell transfusion (OR=1.013, 95%CI: 1.002-1.024) were risk factors of BPD. Conclusions: BPD is more common in very low birth weight infants of male with gestational age less than 32 weeks. Using CPAP in the delivery room, active treatment of NRDS, preventing nosocomial infection, and reducing invasive ventilation and red blood cell transfusion may decrease the incidence of BPD. 目的： 多中心回顾性分析极低及超低出生体重儿支气管肺发育不良（BPD）的临床特点及高危因素。 方法： 采用回顾性病例对照研究。病例来源于2017年全年江苏省新生儿重症监护病房（NICU）母乳质量改进临床研究协作组19家单位的多中心临床数据库，采集登记的胎龄≤34周且住院时间≥28 d的极超低出生体重儿（出生体重<1 500 g）的临床资料。纳入符合条件的768例患儿，其中男376例（49.0%）。按临床诊断分为非BPD组和BPD组，采用χ(2)检验、非参数检验分析BPD的临床特点及潜在的高危因素。构建二分类Logistic回归模型分析BPD发生的危险因素。 结果： 768例患儿中非BPD组577例、BPD组191例，BPD发生率24.9%，其中轻、中、重度构成比分别为73.3%（140例）、23.6%（45例）、3.1%（6例）。BPD组患儿出生胎龄和体重均低于非BPD组[29（28，30）比30（29，31）周、1 170（990，1 300）比1 300（1 160，1 400）g，Z=-9.959、-7.202，P均=0.000]，其中胎龄<28、28~31、32~34周BPD发生率分别为51.7%（46/89）、24.8%（139/561）、5.1%（6/118）；出生体重<1 000、1 000~1 249、1 250~1 500 g BPD发生率分别为62.3%（48/77）、25.9%（70/270）、17.3%（73/421）；BPD组男婴率[55.5%（106/191）]，住院期间常频机械通气率及时间[48.7%（93/191）、120（72，259）h]，产房复苏初始吸入氧浓度及最大吸入氧浓度[0.35（0.30，0.40），0.40（0.30，0.50）]，红细胞悬液输注量[53（30，90）ml]均高于非BPD组[46.8%（270/577）、14.9%（86/577）及80（29，144）h、0.36±0.18及0.39±0.22、38（28，55）ml，χ(2)=4.350、91.640，Z=-3.557、-2.848、-3.776、-4.677，P均<0.05]；而BPD组产房使用持续气道正压通气比例低于非BPD组[12.6%（24/191）比19.4%（112/577），χ(2)=4.614，P=0.032]；BPD组新生儿重度窒息、新生儿呼吸窘迫综合征、新生儿持续肺动脉高压、动脉导管未闭、早产儿贫血、早发败血症、临床败血症及呼吸机相关性肺炎的发生率均高于非BPD组[15.2%（29/191）比4.5%（26/577）、91.1%（174/191）比56.7%（327/577）、2.6%（5/191）比0.2%（1/577）、43.5%（83/191）比34.2%（197/577）、88.0%（168/191）比58.8%（339/577）、15.7%（30/191）比9.9%（57/577）、42.9%（82/191）比18.6%（107/577）、14.1%（27/191）比2.3%（13/577），χ(2)=24.605、74.993、9.167、5.373、61.866、4.557、43.149、34.315，P均<0.05]。多因素Logistic回归分析结果显示：新生儿呼吸窘迫综合征（OR=4.651，95%CI:1.860~11.625），临床败血症（OR=1.989，95%CI: 1.067~3.708），呼吸机相关性肺炎（OR=3.155，95%CI:1.060~9.388），常频机械通气（OR=2.298，95%CI: 1.152~4.586），红细胞悬液输注量（OR=1.013，95%CI: 1.002~1.024）是BPD发生的高危因素。 结论： BPD发生更多集中在出生胎龄<32周的男性极低出生低重儿。预防院内感染，减少有创通气及输血量，积极治疗新生儿呼吸窘迫综合征可能是减少BPD发生的有效手段。.

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