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Title: [Risk factors and short-term prognosis of early pulmonary hypertension in preterm infants].
Author: Wang CH, Chen JJ, Ge JJ, Ma XL, Shi LP.
Journal: Zhonghua Er Ke Za Zhi; 2022 Jul 02; 60(7):682-687. PubMed ID: 35768356.
Abstract:
Objectives: To investigate the risk factors and short-term prognosis of early pulmonary hypertension (PH) in preterm infants. Methods: A retrospective case-control study was performed in preterm infants (gestational age <32 weeks) in the neonatal intensive care unit (NICU) of the Children's Hospital, Zhejiang University School of Medicine from January 2012 to December 2019. Eighty preterm infants with a diagnosis of PH between 3 and 14 days (early PH group) were matched in gestational age and sex with the controls (1∶2) of the same period in NICU. Perinatal clinical records, complications, echocardiography and early outcomes were collected. Characteristics and outcomes were compared between the two groups with t-test, nonparametric test or Chi-square test. Multivariate Logistic regression was used to analyze the predictive factors of early PH. Results: The gestational age of the early PH group and the control group were both (27.9±1.4) weeks, and 52 (65.0%) and 104 (65.0%) were males in each group, respectively. Univariate analysis showed that birth weights were lower in the early PH group than those in the control group (1 030 (850, 1 200) vs. 1 110 (1 000, 1 278) g, Z=-3.27, P=0.001). The early PH group had higher rates of pregnancy-induced hypertension, prolonged rupture of membranes (PROM) >1 week, born by caesarean, small for gestational age (SGA), 1 and 5 min Apgar score ≤7 scores, neonatal respiratory distress syndrome (RDS) and hemodynamic significant patent ductus arteriosus (hsPDA) (12.5% (10/80) vs. 3.8% (6/160), 11.2% (9/80) vs. 3.8% (6/160), 48.8% (39/80) vs. 28.8% (46/160), 10.0% (8/80) vs. 1.9% (3/160), 70.8% (51/72) vs. 51.7% (74/143), 50.0% (36/72) vs. 20.3% (29/143), 88.8% (71/80) vs. 59.4% (95/160), 85.0% (68/80) vs. 22.5% (36/160), χ²=6.56, 5.12, 3.31, 8.05, 7.17, 20.05, 21.58, 84.84, all P<0.05). Multivariate Logistic regression analysis showed that the independent predictive factors of early PH were PROM >1 week, SGA, 5 min Apgar score ≤7 scores, nenonatal RDS and hsPDA (OR=10.40, 18.61, 4.47, 4.13, 20.10, 95%CI 1.93-56.12, 2.82-122.76, 1.91-10.46, 1.50-11.39, 8.28-48.80, all P<0.05),respectively. Infants with early PH had higher incidence of bronchopulmonary dysplasia (BPD), BPD associated PH, severe intraventricular hemorrhage (IVH), extrauterine growth retardation (EUGR), laser treatment for retinopathy of prematurity (ROP) and mortality than the controls (all P<0.05). The duration of invasive mechanical ventilation was also longer in the early PH group than that in the control group (P<0.05). Conclusions: Risk of early PH will be increased in preterm infants with PROM >1 week, SGA, 5 min Apgar score ≤7 scores, and comorbidities of nenonatal RDS and hsPDA. Early PH is associated with increased mortality, BPD, BPD associated PH, severe IVH, EUGR and laser treatment for ROP. 目的： 分析早产儿早期肺动脉高压（PH）的危险因素及近期预后。 方法： 采用病例对照研究，2012年1月至2019年12月浙江大学医学院附属儿童医院新生儿重症监护中心收治的出生胎龄<32周、出生72 h至14 d内存在PH的早产儿80例作为早期PH组，按新生儿重症监护中心收治的同时期出生胎龄及性别因素以1∶2匹配对照组早产儿160例。收集2组的围生期资料、临床合并症、超声心动图资料及近期预后。采用t检验、非参数检验或χ²检验比较2组的临床特征及预后，多因素Logistic回归分析早期PH的危险因素。 结果： 早期PH组和对照组的出生胎龄均为（27.9±1.4）周，男性分别为52例（65.0%）、104例（65.0%）。早期PH组患儿的出生体重明显低于对照组［1 030（850，1 200）比1 110（1 000，1 278）g，Z=-3.27，P=0.001］，母亲妊娠期高血压、胎膜早破>1周、剖宫产出生、小于胎龄儿（SGA）、1 min 和5 min Apgar评分≤7分、新生儿呼吸窘迫综合征（RDS）、有血流动力学意义的动脉导管未闭（hsPDA）发生率均明显高于对照组［12.5%（10/80）比3.8%（6/160）、11.2%（9/80）比3.8%（6/160）、48.8%（39/80）比28.8%（46/160）、10.0%（8/80）比1.9%（3/160）、70.8%（51/72）比51.7%（74/143）、50.0%（36/72）比20.3%（29/143）、88.8%（71/80）比59.4%（95/160）、85.0%（68/80）比22.5%（36/160），χ²=6.56、5.12、3.31、8.05、7.17、20.05、21.58、84.84，均P<0.05］。多因素Logistic回归分析显示胎膜早破>1周、SGA、5 min Apgar评分≤7分、RDS及hsPDA均与早期PH相关（OR=10.40、18.61、4.47、4.13、20.10，95%CI 1.93~56.12、2.82~122.76、1.91~10.46、1.50~11.39、8.28~48.80，均P<0.05）。早期PH组的支气管肺发育不良（BPD）、中重度BPD、BPD相关性PH、36周机械通气、重度脑室内出血、宫外生长发育迟缓、早产儿视网膜病激光术比例、病死率均明显高于对照组（均P<0.05），气管插管机械通气时间明显长于对照组（P<0.05）。 结论： 胎膜早破>1周、SGA、5 min Apgar评分≤7分合并新生儿RDS及hsPDA的早产儿发生早期PH的风险增加。早期PH早产儿的病死率高，BPD及BPD相关性PH、重度脑室内出血、宫外生长发育迟缓及早产儿视网膜病等合并症发生率高，预后相对不良。.

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