Analysis of influencing factors of very low birth weight infants with bronchopulmonary dysplasia

doi:10.3877/cma.j.issn.1673-5250.2017.05.004

Objective

To explorer the influencing factors of very low birth weight infants (VLBWI) with bronchopulmonary dysplasia (BPD).

Methods

A total of 163 VLBWI in neonatal intensive care unit of West China Second University Hospital, Sichuan University, from January to December 2015, were chosen as study subjects. They were divided into BPD group(n=57) and non BPD group (n=106) according to discharged diagnosis. Clinical data were analyzed retrospectively, and following factors were compared statistically to explore the influences on BPD in VLBWI. ① A total of 12 items of maternal prenatal conditions between 2 groups, including age, parity, primiparity, multifetation, regular prenatal examination, complications at delivery, delivery mode, etc.. ② A total of 14 items of neonatal conditions, including gestational age, birth weight, gender, 1 min and 5 min Apgar scores, postnatal usage of pulmonary surfactant (PS), usage rate and duration of mechanical ventilation and postnatal complications.etc.. Based on the results of existing studies, clinical experience and results of univariate analysis, multivariate unconditional logistic regression analysis was performed about the 13 factors with significant differences, in order to discuss independent impact factors about BPD in VLBWI.

Results

①Results of univariate analysis showed that: the ratio of hypertension or preeclampsia during pregnancy and caesarean section of maternal in BPD group were lower than those of non BPD group, but the ratio of antepartum hemorrhage was higher than that of non BPD group, and the differences were statistically significant (P<0.05). Gestational age and birth weight of VLBWI in BPD group were younger or lighter than those of non BPD group. Ratio of Apgar score≤7 scores of 1 min and 5 min after birth, usage rate of PS, usage rate and duration of mechanical ventilation, incidence rates of neonatal respiratory distress syndrome (NRDS), patent ductus arteriosus (PDA) and periventricular-intraventricular hemorrhage/periventricular leukomalacia (PIVH/PVL) of neonates in BPD group were all higher or longer than those of non BPD group, and the differences were statistically significant (P<0.05). ②Results of multivariate unconditional logistic regression analysis showed that: gestational age<29.5 weeks(OR=3.876, 95%CI: 1.260-11.924, P<0.05), birth weight<1 300 g (OR=3.983, 95%CI: 1.165-13.621, P<0.05) were independent risk factors about suffering BPD in VLBWI; duration of mechanical ventilation<7 d (OR=0.146, 95%CI: 0.050-0.424, P<0.05) was an independent protection factor about suffering BPD in VLBWI.

Conclusion

Avoiding premature delivery and proper mechanical ventilation strategy might reduce the incidence rate of BPD in VLBWI.

Key words: Bronchopulmonary dysplasia, Risk factors, Infant, very low birth weight

表1 2组极低出生体重儿母亲产前一般临床资料比较

组别	例数	年龄(岁，±s)	胎次[次，M(P₂₅～P₇₅)]	初产妇[例数(%)]	多胎妊娠[例数(%)]	规律产前检查[例数(%)]	妊娠期糖尿病[例数(%)]
BPD组	57	30.1±4.4	2.0(1.0～3.0)	19(33.3)	31(54.4)	48(84.2)	19(33.3)
非BPD组	106	30.4±5.1	2.0(1.0～3.0)	38(35.8)	48(45.3)	79(74.5)	25(23.6)
检验值	?	t＝－3.900	Z＝－0.316	χ²＝0.187	χ²＝1.230	χ²＝2.019	χ²＝1.787
P值	?	0.697	0.752	0.665	0.325	0.172	0.181
组别	例数	妊娠期高血压或子痫前期[例数(%)]	产前出血[例数(%)]	胎膜早破[例数(%)]	产前使用糖皮质激素[例数(%)]	剖宫产[例数(%)]	产前合并感染[例数(%)]
BPD组	57	4(7.0)	22(38.6)	23(40.4)	44(77.2)	18(31.6)	45(79.0)
非BPD组	106	24(22.6)	16(15.1)	41(38.7)	67(63.2)	63(59.4)	73(68.9)
检验值	?	χ²＝6.360	χ²＝11.450	χ²＝0.043	χ²＝3.327	χ²＝11.510	χ²＝1.884
P值	?	0.015	0.001	0.835	0.079	0.001	0.201

表1 2组极低出生体重儿母亲产前一般临床资料比较

组别	例数	年龄(岁，±s)	胎次[次，M(P₂₅～P₇₅)]	初产妇[例数(%)]	多胎妊娠[例数(%)]	规律产前检查[例数(%)]	妊娠期糖尿病[例数(%)]
BPD组	57	30.1±4.4	2.0(1.0～3.0)	19(33.3)	31(54.4)	48(84.2)	19(33.3)
非BPD组	106	30.4±5.1	2.0(1.0～3.0)	38(35.8)	48(45.3)	79(74.5)	25(23.6)
检验值	?	t＝－3.900	Z＝－0.316	χ²＝0.187	χ²＝1.230	χ²＝2.019	χ²＝1.787
P值	?	0.697	0.752	0.665	0.325	0.172	0.181
组别	例数	妊娠期高血压或子痫前期[例数(%)]	产前出血[例数(%)]	胎膜早破[例数(%)]	产前使用糖皮质激素[例数(%)]	剖宫产[例数(%)]	产前合并感染[例数(%)]
BPD组	57	4(7.0)	22(38.6)	23(40.4)	44(77.2)	18(31.6)	45(79.0)
非BPD组	106	24(22.6)	16(15.1)	41(38.7)	67(63.2)	63(59.4)	73(68.9)
检验值	?	χ²＝6.360	χ²＝11.450	χ²＝0.043	χ²＝3.327	χ²＝11.510	χ²＝1.884
P值	?	0.015	0.001	0.835	0.079	0.001	0.201

表2 2组极低出生体重儿一般临床资料比较

组别	例数	胎龄(周，±s)	出生体重(g，±s)	男性患儿[例数(%)]	出生后1 minApgar评分≤7分[例数(%)]	出生后5 minApgar评分≤7分[例数(%)]	使用PS[例数(%)]	PS使用≥2次[例数(%)]
BPD组	57	28.9±1.0	1 132±168	30(52.6)	30(52.6)	12(21.1)	50(87.7)	4(7.0)
非BPD组	106	31.6±1.7	1 308±141	43(40.6)	29(27.4)	6(5.7)	37(34.9)	1(0.9)
检验值	?	t＝－12.810	t′＝－7.040	χ²＝2.182	χ²＝8.983	χ²＝8.440	χ²＝41.546	χ²＝4.600
P值	?	<0.001	<0.001	0.140	0.004	0.008	<0.001	0.051
组别	例数	机械通气[例数(%)]	机械通气时间(d，±s)	NRDS[例数(%)]	PDA[例数(%)]	肺出血[例数(%)]	新生儿坏死性小肠结肠炎[例数(%)]	PIVH/PVL[例数(%)]
BPD组	57	57(100.0)	3.0±4.4	48(84.2)	46(80.7)	3(5.3)	1(1.8)	44(77.2)
非BPD组	106	62(58.5)	0.3±1.2	37(34.9)	69(65.1)	1(0.9)	6(5.7)	64(60.3)
检验值	?	χ²＝32.409	t′＝4.487	χ²＝36.110	χ²＝4.346	χ²＝2.890	χ²＝1.376	χ²＝4.688
P值	?	<0.001	<0.001	<0.001	0.043	0.123	0.423	0.037

表2 2组极低出生体重儿一般临床资料比较

组别	例数	胎龄(周，±s)	出生体重(g，±s)	男性患儿[例数(%)]	出生后1 minApgar评分≤7分[例数(%)]	出生后5 minApgar评分≤7分[例数(%)]	使用PS[例数(%)]	PS使用≥2次[例数(%)]
BPD组	57	28.9±1.0	1 132±168	30(52.6)	30(52.6)	12(21.1)	50(87.7)	4(7.0)
非BPD组	106	31.6±1.7	1 308±141	43(40.6)	29(27.4)	6(5.7)	37(34.9)	1(0.9)
检验值	?	t＝－12.810	t′＝－7.040	χ²＝2.182	χ²＝8.983	χ²＝8.440	χ²＝41.546	χ²＝4.600
P值	?	<0.001	<0.001	0.140	0.004	0.008	<0.001	0.051
组别	例数	机械通气[例数(%)]	机械通气时间(d，±s)	NRDS[例数(%)]	PDA[例数(%)]	肺出血[例数(%)]	新生儿坏死性小肠结肠炎[例数(%)]	PIVH/PVL[例数(%)]
BPD组	57	57(100.0)	3.0±4.4	48(84.2)	46(80.7)	3(5.3)	1(1.8)	44(77.2)
非BPD组	106	62(58.5)	0.3±1.2	37(34.9)	69(65.1)	1(0.9)	6(5.7)	64(60.3)
检验值	?	χ²＝32.409	t′＝4.487	χ²＝36.110	χ²＝4.346	χ²＝2.890	χ²＝1.376	χ²＝4.688
P值	?	<0.001	<0.001	<0.001	0.043	0.123	0.423	0.037

表3 极低出生体重儿发生支气管肺发育不良影响因素的多因素非条件logistic回归分析的变量含义及赋值情况

解释变量/结局变量	变量名	赋值
BPD	y	y＝0表示未发生BPD，y＝1表示发生BPD
母亲妊娠期高血压疾病	x₁	x₁＝0表示未合并妊娠期高血压疾病，x₁＝1表示合并妊娠期高血压疾病
母亲产前出血	x₂	x₂＝0表示未发生产前出血，x₂＝1表示发生产前出血
剖宫产分娩	x₃	x₃＝0表示非剖宫产分娩，x₃＝1表示剖宫产分娩
VLBWI胎龄	x₄	x₄＝0表示VLBWI胎龄≥29.5周，x₄＝1表示VLBWI胎龄<29.5周
VLBWI出生体重	x₅	x₅＝0表示VLBWI出生体重≥1 300 g，x₅＝1表示VLBWI出生体重<1 300 g
出生后1 min Apgar评分	x₆	x₆＝0表示出生后1 min Apgar评分>7分，x_6＝1表示出生后1 min Apgar评分≤7分
出生后5 min Apgar评分	x₇	x₇＝0表示出生后5 min Apgar评分>7分，x₇＝1表示出生后5 min Apgar评分≤7分
使用PS	x₈	x₈＝0表示未使用PS，x₈＝1表示使用PS
VLBWI机械通气	x₉	x₉＝0表示未使用机械通气，x₉＝1表示使用机械通气
VLBWI机械通气时间	x₁₀	x₁₀＝0表示机械通气时间≥7 d，x₁₀＝1表示机械通气时间<7 d
合并NRDS	x₁₁	x₁₁＝0表示未合并NRDS，x₁₁＝1表示合并NRDS
合并PDA	x₁₂	x₁₂＝0表示未合并PDA，x₁₂＝1表示合并PDA
合并PIVH/PVL	x₁₃	x₁₃＝0表示未合并PIVH/PVL，x₁₃＝1表示合并PIVH/PVL

表3 极低出生体重儿发生支气管肺发育不良影响因素的多因素非条件logistic回归分析的变量含义及赋值情况

解释变量/结局变量	变量名	赋值
BPD	y	y＝0表示未发生BPD，y＝1表示发生BPD
母亲妊娠期高血压疾病	x₁	x₁＝0表示未合并妊娠期高血压疾病，x₁＝1表示合并妊娠期高血压疾病
母亲产前出血	x₂	x₂＝0表示未发生产前出血，x₂＝1表示发生产前出血
剖宫产分娩	x₃	x₃＝0表示非剖宫产分娩，x₃＝1表示剖宫产分娩
VLBWI胎龄	x₄	x₄＝0表示VLBWI胎龄≥29.5周，x₄＝1表示VLBWI胎龄<29.5周
VLBWI出生体重	x₅	x₅＝0表示VLBWI出生体重≥1 300 g，x₅＝1表示VLBWI出生体重<1 300 g
出生后1 min Apgar评分	x₆	x₆＝0表示出生后1 min Apgar评分>7分，x_6＝1表示出生后1 min Apgar评分≤7分
出生后5 min Apgar评分	x₇	x₇＝0表示出生后5 min Apgar评分>7分，x₇＝1表示出生后5 min Apgar评分≤7分
使用PS	x₈	x₈＝0表示未使用PS，x₈＝1表示使用PS
VLBWI机械通气	x₉	x₉＝0表示未使用机械通气，x₉＝1表示使用机械通气
VLBWI机械通气时间	x₁₀	x₁₀＝0表示机械通气时间≥7 d，x₁₀＝1表示机械通气时间<7 d
合并NRDS	x₁₁	x₁₁＝0表示未合并NRDS，x₁₁＝1表示合并NRDS
合并PDA	x₁₂	x₁₂＝0表示未合并PDA，x₁₂＝1表示合并PDA
合并PIVH/PVL	x₁₃	x₁₃＝0表示未合并PIVH/PVL，x₁₃＝1表示合并PIVH/PVL

表4 极低出生体重儿发生支气管肺发育不良影响因素的多因素非条件logistic回归分析

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
母亲妊娠期高血压疾病	－1.245	1.014	1.507	0.220	0.288	0.039～2.101
母亲产前出血	0.840	0.663	1.602	0.206	2.315	0.631～8.496
剖宫产分娩	－0.877	0.616	2.023	0.155	0.416	0.124～1.393
VLBWI胎龄	1.355	0.573	5.585	0.018	3.876	1.260～11.924
VLBWI出生体重	1.382	0.627	4.853	0.028	3.983	1.165～13.621
出生后1 min Apgar评分	0.110	0.646	0.029	0.864	1.117	0.315～3.957
出生后5 min Apgar评分	0.350	0.936	0.140	0.709	1.419	0.226～8.893
使用PS	17.332	4 569.510	0.000	0.997	3.366×10⁷	0.000～0.000
VLBWI机械通气	31.299	6 475.981	0.000	0.996	3.916×10¹³	0.000～0.000
VLBWI机械通气时间	－1.927	0.546	12.453	<0.001	0.146	0.050～0.424
合并NRDS	－16.580	4 569.510	0.000	0.997	0.000	0.000～0.000
合并PDA	0.573	0.632	0.822	0.365	1.773	0.514～6.119
合并PIVH/PVL	0.614	0.894	0.472	0.492	1.848	0.321～10.647

表4 极低出生体重儿发生支气管肺发育不良影响因素的多因素非条件logistic回归分析

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
母亲妊娠期高血压疾病	－1.245	1.014	1.507	0.220	0.288	0.039～2.101
母亲产前出血	0.840	0.663	1.602	0.206	2.315	0.631～8.496
剖宫产分娩	－0.877	0.616	2.023	0.155	0.416	0.124～1.393
VLBWI胎龄	1.355	0.573	5.585	0.018	3.876	1.260～11.924
VLBWI出生体重	1.382	0.627	4.853	0.028	3.983	1.165～13.621
出生后1 min Apgar评分	0.110	0.646	0.029	0.864	1.117	0.315～3.957
出生后5 min Apgar评分	0.350	0.936	0.140	0.709	1.419	0.226～8.893
使用PS	17.332	4 569.510	0.000	0.997	3.366×10⁷	0.000～0.000
VLBWI机械通气	31.299	6 475.981	0.000	0.996	3.916×10¹³	0.000～0.000
VLBWI机械通气时间	－1.927	0.546	12.453	<0.001	0.146	0.050～0.424
合并NRDS	－16.580	4 569.510	0.000	0.997	0.000	0.000～0.000
合并PDA	0.573	0.632	0.822	0.365	1.773	0.514～6.119
合并PIVH/PVL	0.614	0.894	0.472	0.492	1.848	0.321～10.647

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