Risk factors and respiratory disease related follow-up analysis of bronchopulmonary dysplasia in premature infants with respiratory distress syndrome

doi:10.11852/zgetbjzz2018-0777

Abstract

Abstract: Objectives To explore the risk factors of bronchopulmonary dysplasia(BPD) in premature infants with neonatal respiratory distress syndrome(NRDS),and to observe the outcome of follow-up. Methods Preterm infants hospitalized in the Neonatal Pediatrics Department of Beijing Friendship Hospital Affiliated to Capital Medical University and diagnosed with NRDS were enrolled in this study from 1st January,2013 to 31st December,2016,and were divided into BPD group and control group(non-BPD group).The risk factors of BPD in premature infants with NRDS were analyzed.After discharge,the patients was followed up by telephone or through the outpatient to observe the incidence of respiratory infection,wheezing times and readmission rate under one year old,as well as the pulmonary function after 2 years old. Results Totally 79 children were enrolled in this study,of which 32 cases were in BPD group,and 47 cases were in control group.Single factor analysis showed that gestational age and birth weight in BPD group were significantly lower than those in control group(P＜0.01),and the time for mechanical ventilation,the ratio of the application of PS and maternal eclampsia during pregnancy were significantly higher than those in control group(P＜0.01).However,there were no significant differences on maternal age,the ratio of premature rupture of membranes and gestational diabetes(P＞0.05).The incidence of respiratory tract infection and wheezing times in BPD group was significantly higher than those in control group within one year after birth(P<0.01),but there were no significant differences on the readmission rate under 1 year old and pulmonary function in 2 years old between the two groups(P＞0.05).Multivariable Logistic regression analysis indicated that the gestational age(≤28 weeks OR=23.00,95%CI:6.767-78.172;>28-32 weeks OR=4.518,95%CI:1.359-15.020) and mechanical ventilation time more than 7 days(OR=4.380,95%CI:2.581-6.146) were risk factors for BPD. Conclusions Gestational age and mechanical ventilation more than 7 days may be the risk factors for BPD in NRDS premature infants.BPD may lead to repeated respiratory tract infection and wheezing in infants and young children,and whether it can lead to the change of long-term pulmonary function or not needs to be further studied.

Key words: neonatal respiratory distress syndrome, bronchopulmonary dysplasia, recurrent respiratory infections, wheezing, premature infants

摘要： 目的探讨罹患新生儿呼吸窘迫综合征(NRDS)的早产儿发生支气管肺发育不良(BPD)的危险因素及随访结局。方法以2013年1月1日—2016年12月31日在首都医科大学附属北京友谊医院新生儿科住院并诊断为NRDS的早产儿为研究对象。根据是否诊断BPD分为BPD组和对照组(非BPD组),研究患NRDS的早产儿发生BPD的危险因素,并在出院后进行电话或门诊随访,观察其1岁内呼吸道感染及喘息的发生次数、再住院率及部分患儿2岁以后的肺功能情况。结果共纳入79例患儿,其中BPD组32例,对照组47例。单因素分析显示,BPD组患儿胎龄及出生体重显著低于对照组,机械通气时间、应用肺表面活性物质人数及母亲患妊娠子痫比例明显高于对照组(P<0.01),而母亲年龄、是否有分娩前胎膜早破及妊娠期糖尿病两组间差异无统计学意义(P>0.05)。BPD组患儿生后1年内患呼吸道感染及喘息的次数明显高于对照组(P<0.01),而两组患儿1岁内再入院率、2岁后肺功能差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,患儿胎龄(≤28周OR=23.00,95%CI:6.767~78.172;>28~32周OR=4.518,95%CI:1.359~15.020),与机械通气>7 d(OR=4.380,95%CI:2.581~6.146)为发生BPD的危险因素。结论胎龄及机械通气>7 d可能为NRDS早产儿发生BPD的危险因素。BPD可能导致患儿婴幼儿期的反复呼吸道感染及喘息发作,而是否会导致患儿远期肺功能的改变有待于进一步的研究。

关键词: 新生儿呼吸窘迫综合征, 支气管肺发育不良, 反复呼吸道感染, 喘息, 早产儿

CLC Number:

R722.6

YANG Nan, CUI Hong, XU Jun-mei. Risk factors and respiratory disease related follow-up analysis of bronchopulmonary dysplasia in premature infants with respiratory distress syndrome[J]. journal1, 2019, 27(10): 1098-1101.

杨楠, 崔红, 徐俊梅. 呼吸窘迫综合征早产儿发生支气管肺发育不良的危险因素及呼吸道疾病随访分析[J]. 中国儿童保健杂志, 2019, 27(10): 1098-1101.

References

[1] Vom HM,Prenzel F,Uhlig HH,et al. Pulmonary outcome in former preterm,very low birth weight children with bronchopulmonary dysplasia:a case-control follow-up at school age[J] . J Pediatr,2014,164(1):40-45.
[2] Lapcharoensap W,Gage SC,Kan P,et al. Hospital variation and risk factors for bronchopulmonary dysplasia in a population-based cohort[J] . JAMA Pediatr,2015,169(2):e 143676.
[3] 邵肖梅,叶鸿瑁,丘小汕,等. 实用新生儿学[M] .4版,北京:人民卫生出版社,2011:396-397.
[4] Bhandari A,Bhandari V. Pitfalls,problems,and progress in bronchopulmonary dysplasia[J] . Pediatrics,2009,123(6):1562-1573.
[5] 张慧,富建华,薛辛东,等.机械通气早产儿支气管肺发育不良的高危因素分析[J] .中国小儿急救医学,2011,3(5):240-242.
[6] Guimaraes H,Rocha G,Vasconeellos G,et al. Risk factors for bronchopulmonary dysplasia in five Portuguese neonatal intensive care units[J] . Rev Port Pneumol,2010,16(3):419-430.
[7] Klinger G,Sokolover N,Boyko V,et al. Perinatal risk factors for bronchopulmonary dysplasia in a national cohort of very-low-birthweight infants[J] . Am J Obstet Gynecol,2013,208(2):111-115.
[8] 尹燕丹,祁媛媛,洪达,等. 早产儿支气管肺发育不良危险因素及2岁时随访结局[J] . 中国循证儿科杂志,2016,11(2):113-117.
[9] Philip AG. Bronchopulmonary dysplasia:then and now[J] . Neonatology,2012,102(1):1-8.
[10] Niedermaier S,Hilgendorff A. Bronchopulmonary dysplasia-an overview about pathophysiologic concepts[J] . Mol Cell Pediatr,2015,2(1):2.
[11] 张国强,刘欣,刘曼,等. 新生儿支气管肺发育不良从经典到新型的研究进展[J] . 中国儿童保健杂志,2015,23(11):1163-1165.
[12] Lim G,Lee BS,Choi YS,et al. Delayed dexamethasone therapy and neurodevelopmental outcomes in preterm infants with bronchopulmonary dysplasia[J] . Pediatr Neonatol,2015,56(4):261-267.
[13] Doyle LW,Halliday HL,Ehrenkranz RA,et al. An update on the impact of postnatal systemic corticosteroids on mortality and cerebral palsy in preterm infants:effect modification by risk of bronchopulmonary dysplasia[J] . J Pediatr,2014,165(6):1258-1260.
[14] Praprotnik M,Stucin Gantar I,Lu ovnik M,et al. Respiratory morbidity,lung function and fitness assessment after bronchopulmonary dysplasia[J] . J Perinatol,2015,35(12):1037-1042.
[15] Priante E,Moschino L,Mardegan V,et al. Respiratory outcome after preterm birth:a long and difficult journey[J] . Am J Perinatol,2016,33(11):1040-1042.
[16] Thunqvist P,Gustafsson P,Norman M,et al. Lung function at 6 and 18 months after preterm birth in relation to severity of bronchopulmonary dysplasia[J] . Pediatr Pulmonol,2015,50(10):978-986.