Analysis of risk factors for bronchopulmonary dysplasia in very low birth weight preterm infants

doi:10.3877/cma.j.issn.1673-5250.2019.03.013

Objective

To analyze risk factors for bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) preterm infants.

Methods

A total of 107 preterm infants with birth weight <1 500 g were collected from Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region from January 1 to December 31, 2014. According to whether be diagnosed as BPD, they were divided into BPD group (n=36) and non-BPD group (n=71). Clinical data of 107 preterm infants were analyzed retrospectively, including obstetric factors, general condition of preterm infants at birth, treatment processes and main complications, totally 4 aspects of 26 observation factors. Eight obstetric factors and 10 factors related to general conditions at birth and treatments of preterm infants were compared between two groups using t test and chi-square test for univariate analysis. Univariate logistic regression analysis was used to analyze the 8 complication factors of preterm infants during hospitalization. Then, with the existed research results, clinical experiences and univariate factor analysis results, 13 possible influencing factors of BPD occurrence in VLBW preterm infants were analyzed by multivariate unconditional logistic regression analysis in order to explore the independent influencing factors associated with the BPD in VLBW preterm infants. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

Results

①The results of univariate analysis of the factors associated with occurrence of BPD in VLBW preterm infants demonstrated that statistical differences presented on delivery mode, intrauterine infection, birthweight and gestational age of preterm infants, asphyxia of newborn, nasal continuous positive airway pressure (NCPAP), invasive ventilation, the duration of invasive ventilation, inhalation of high concentration oxygen, administration of pulmonary surfactant (PS), neonatal respiratory distress syndrome (NRDS), patent ductus arteriosus (PDA) and sepsis. ② Multivariate unconditional logistic regression analysis showed that administration of invasive ventilation (OR=51.936, 95%CI: 2.395-1 126.182, P=0.012), inhalation of high concentration oxygen (OR=76.269, 95%CI: 5.279-1 101.998, P=0.001), NRDS (OR=4.497, 95%CI: 1.772-11.415, P=0.002), and complicated with sepsis (OR=2.521, 95%CI: 1.006-6.319, P=0.049) were independent risk factors of BPD occurrence in VLBW preterm infants. Cesarean section (OR=0.045, 95%CI: 0.003-0.730, P=0.029) was protective factor of BPD occurrence in VLBW preterm infants.

Conclusions

If VLBW preterm infants receive invasive ventilation, inhaled high concentration oxygen, complicated with NRDS or sepsis, it would be more likely to suffer from BPD. Pointed measures aimed of these factors should be taken in clinical practice to prevent BPD occurrence in VLBW preterm infants.

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

表1 极低出生体重早产儿发生支气管肺发育不良可能影响因素的单因素分析结果

组别	例数	母亲年龄(岁，±s)	产前应用激素[例数(%)]	胎儿宫内窘迫[例数(%)]	胎膜早破≥24 h [例数(%)]	分娩方式[例数(%)]		宫内感染[例数(%)]
组别	例数	母亲年龄(岁，±s)	产前应用激素[例数(%)]	胎儿宫内窘迫[例数(%)]	胎膜早破≥24 h [例数(%)]	经阴道分娩	剖宫产术	宫内感染[例数(%)]
BPD组	36	29.3±5.0	21(58.3)	8(22.2)	12(33.3)	23(63.9)	13(36.1)	9(25.0)
非BPD组	71	28.5±5.1	28(39.4)	12(16.9)	14(19.7)	25(35.2)	46(64.8)	7(9.9)
检验值	?	t＝0.764	χ²＝3.436	χ²＝0.445	χ²＝2.407	χ²＝6.646		χ²＝4.306
P值	?	0.447	0.064	0.505	0.121	0.010		0.038
组别	例数	妊娠期糖尿病[例数(%)]	妊娠期高血压疾病[例数(%)]	IVF-ET [例数(%)]	新生儿性别[例数(%)]		出生体重(g，±s)	胎龄(周，±s)
组别	例数	妊娠期糖尿病[例数(%)]	妊娠期高血压疾病[例数(%)]	IVF-ET [例数(%)]	男	女	出生体重(g，±s)	胎龄(周，±s)
BPD组	36	2(5.6)	3(8.3)	5(13.9)	29(80.6)	7(19.4)	1 181±157	28.6±1.3
非BPD组	71	1(1.4)	10(14.1)	3(4.2)	46(64.9)	25(35.2)	1 313±144	31.0±1.9
检验值	?	χ²＝0.370 ^a	χ²＝0.740	χ²＝3.225	χ²＝2.833		t＝4.344	t＝6.918
P值	?	0.543	0.350	0.073	0.092		<0.001	<0.001
组别	例数	新生儿窒息[例数(%)]	NCPAP[例数(%)]	有创机械通气[例数(%)]	有创机械通气时间(h，±s)	吸入高浓度氧^b[例数(%)]	PS使用率[例数(%)]
BPD组	36	11(30.6)	35(97.2)	31(86.1)	6.2±3.0	34(94.4)	29(80.6)
非BPD组	71	9(12.7)	47(66.2)	13(18.3)	5.1±2.0	18(25.4)	35(49.3)
检验值	?	χ²＝5.917	χ²＝12.841	χ²＝45.355	t＝2.256	χ²＝45.650	χ²＝9.711
P值	?	0.048	<0.001	<0.001	0.026	<0.001	0.002

表1 极低出生体重早产儿发生支气管肺发育不良可能影响因素的单因素分析结果

组别	例数	母亲年龄(岁，±s)	产前应用激素[例数(%)]	胎儿宫内窘迫[例数(%)]	胎膜早破≥24 h [例数(%)]	分娩方式[例数(%)]		宫内感染[例数(%)]
组别	例数	母亲年龄(岁，±s)	产前应用激素[例数(%)]	胎儿宫内窘迫[例数(%)]	胎膜早破≥24 h [例数(%)]	经阴道分娩	剖宫产术	宫内感染[例数(%)]
BPD组	36	29.3±5.0	21(58.3)	8(22.2)	12(33.3)	23(63.9)	13(36.1)	9(25.0)
非BPD组	71	28.5±5.1	28(39.4)	12(16.9)	14(19.7)	25(35.2)	46(64.8)	7(9.9)
检验值	?	t＝0.764	χ²＝3.436	χ²＝0.445	χ²＝2.407	χ²＝6.646		χ²＝4.306
P值	?	0.447	0.064	0.505	0.121	0.010		0.038
组别	例数	妊娠期糖尿病[例数(%)]	妊娠期高血压疾病[例数(%)]	IVF-ET [例数(%)]	新生儿性别[例数(%)]		出生体重(g，±s)	胎龄(周，±s)
组别	例数	妊娠期糖尿病[例数(%)]	妊娠期高血压疾病[例数(%)]	IVF-ET [例数(%)]	男	女	出生体重(g，±s)	胎龄(周，±s)
BPD组	36	2(5.6)	3(8.3)	5(13.9)	29(80.6)	7(19.4)	1 181±157	28.6±1.3
非BPD组	71	1(1.4)	10(14.1)	3(4.2)	46(64.9)	25(35.2)	1 313±144	31.0±1.9
检验值	?	χ²＝0.370 ^a	χ²＝0.740	χ²＝3.225	χ²＝2.833		t＝4.344	t＝6.918
P值	?	0.543	0.350	0.073	0.092		<0.001	<0.001
组别	例数	新生儿窒息[例数(%)]	NCPAP[例数(%)]	有创机械通气[例数(%)]	有创机械通气时间(h，±s)	吸入高浓度氧^b[例数(%)]	PS使用率[例数(%)]
BPD组	36	11(30.6)	35(97.2)	31(86.1)	6.2±3.0	34(94.4)	29(80.6)
非BPD组	71	9(12.7)	47(66.2)	13(18.3)	5.1±2.0	18(25.4)	35(49.3)
检验值	?	χ²＝5.917	χ²＝12.841	χ²＝45.355	t＝2.256	χ²＝45.650	χ²＝9.711
P值	?	0.048	<0.001	<0.001	0.026	<0.001	0.002

表2 产科因素、早产儿出生及治疗经过因素中，极低出生体重早产儿发生支气管肺发育不良可能影响因素的多因素非条件logistic回归分析变量含义及其赋值情况

自变量/因变量	变量名	赋值
BPD	y	y＝0表示发生，y＝1表示未发生
分娩方式	x₁	x₁＝0表示经阴道分娩，x₁＝1表示剖宫产术分娩
宫内感染	x₂	x₂＝0表示未发生，x₂＝1表示发生
出生体重	x₃	x₃＝0表示750～999 g，x₃＝1表示1 000～1 249 g，x₃＝2表示1 250～1 499 g
胎龄	x₄	x₄＝0表示25～28^＋6周，x₄＝1表示29～32^＋6周，x₄＝2表示33～36^＋6周
新生儿窒息	x₅	x₅＝0表示未发生，x₅＝1表示发生
NCPAP	x₆	x₆＝0表示未使用，x₆＝1表示使用
有创机械通气	x₇	x₇＝0表示未使用，x₇＝1表示使用
有创机械通气时间	x₈	x₈＝0表示≤7 d，x₈＝1表示>7 d
吸入高浓度氧^a	x₉	x₉＝0表示未吸入，x₉＝1表示吸入
PS	x₁₀	x₁₀＝0表示未使用，x₁₀＝1表示使用

自变量/因变量	变量名	赋值
BPD	y	y＝0表示发生，y＝1表示未发生
分娩方式	x₁	x₁＝0表示经阴道分娩，x₁＝1表示剖宫产术分娩
宫内感染	x₂	x₂＝0表示未发生，x₂＝1表示发生
出生体重	x₃	x₃＝0表示750～999 g，x₃＝1表示1 000～1 249 g，x₃＝2表示1 250～1 499 g
胎龄	x₄	x₄＝0表示25～28^＋6周，x₄＝1表示29～32^＋6周，x₄＝2表示33～36^＋6周
新生儿窒息	x₅	x₅＝0表示未发生，x₅＝1表示发生
NCPAP	x₆	x₆＝0表示未使用，x₆＝1表示使用
有创机械通气	x₇	x₇＝0表示未使用，x₇＝1表示使用
有创机械通气时间	x₈	x₈＝0表示≤7 d，x₈＝1表示>7 d
吸入高浓度氧^a	x₉	x₉＝0表示未吸入，x₉＝1表示吸入
PS	x₁₀	x₁₀＝0表示未使用，x₁₀＝1表示使用

表3 产科因素、早产儿出生及治疗经过因素中，极低出生体重早产儿发生支气管肺发育不良10项可能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
分娩方式		－3.091	1.417	4.761	0.029	0.045	0.003～0.730
宫内感染		1.952	1.555	1.577	0.209	7.043	0.335～148.260
出生体重(g)		?	?	?	?	?	?
?	1 000～1 249	1.063	2.378	0.200	0.655	2.896	0.027～306.405
?	750～999	3.708	2.260	2.692	0.101	40.758	0.486～3 421.075
胎龄(周)		?	?	?	?	?	?
?	29～32^＋6	－49.210	2.749	0.000	1.000	0.000	0.000
?	25～28^＋6	－0.721	1.600	0.203	0.652	0.486	0.021～11.187
新生儿窒息		1.690	1.405	1.448	0.229	5.421	0.345～85.067
NCPAP		0.790	1.685	0.220	0.639	2.203	0.081～59.833
有创机械通气		3.950	1.570	6.332	0.012	51.936	2.395～1 126.182
有创机械通气时间		1.326	1.242	1.140	0.286	3.765	0.330～42.910
吸入高浓度氧^a		4.334	1.363	10.118	0.001	76.269	5.279～1 101.998
PS		－1.390	1.266	1.206	0.272	0.249	0.021～2.979

表3 产科因素、早产儿出生及治疗经过因素中，极低出生体重早产儿发生支气管肺发育不良10项可能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
分娩方式		－3.091	1.417	4.761	0.029	0.045	0.003～0.730
宫内感染		1.952	1.555	1.577	0.209	7.043	0.335～148.260
出生体重(g)		?	?	?	?	?	?
?	1 000～1 249	1.063	2.378	0.200	0.655	2.896	0.027～306.405
?	750～999	3.708	2.260	2.692	0.101	40.758	0.486～3 421.075
胎龄(周)		?	?	?	?	?	?
?	29～32^＋6	－49.210	2.749	0.000	1.000	0.000	0.000
?	25～28^＋6	－0.721	1.600	0.203	0.652	0.486	0.021～11.187
新生儿窒息		1.690	1.405	1.448	0.229	5.421	0.345～85.067
NCPAP		0.790	1.685	0.220	0.639	2.203	0.081～59.833
有创机械通气		3.950	1.570	6.332	0.012	51.936	2.395～1 126.182
有创机械通气时间		1.326	1.242	1.140	0.286	3.765	0.330～42.910
吸入高浓度氧^a		4.334	1.363	10.118	0.001	76.269	5.279～1 101.998
PS		－1.390	1.266	1.206	0.272	0.249	0.021～2.979

表4 住院期间并发症中，极低出生体重早产儿发生支气管肺发育不良影响因素的单因素及多因素非条件logistic回归分析变量含义及赋值情况

自变量/因变量	变量名	赋值
BPD	y	y＝0表示发生，y＝1表示未发生
NRDS	x₁	x₁＝0表示未发生，x₁＝1表示发生
PDA	x₂	x₂＝0表示未发生，x₂＝1表示发生
新生儿肺炎	x₃	x₃＝0表示未发生，x₃＝1表示发生
败血症	x₄	x₄＝0表示未发生，x₄＝1表示发生
代谢性酸中毒	x₅	x₅＝0表示未发生，x₅＝1表示发生
IVH	x₆	x₆＝0表示未发生，x₆＝1表示发生
NEC	x₇	x₇＝0表示未发生，x₇＝1表示发生
真菌感染	x₈	x₈＝0表示未发生，x₈＝1表示发生

表4 住院期间并发症中，极低出生体重早产儿发生支气管肺发育不良影响因素的单因素及多因素非条件logistic回归分析变量含义及赋值情况

自变量/因变量	变量名	赋值
BPD	y	y＝0表示发生，y＝1表示未发生
NRDS	x₁	x₁＝0表示未发生，x₁＝1表示发生
PDA	x₂	x₂＝0表示未发生，x₂＝1表示发生
新生儿肺炎	x₃	x₃＝0表示未发生，x₃＝1表示发生
败血症	x₄	x₄＝0表示未发生，x₄＝1表示发生
代谢性酸中毒	x₅	x₅＝0表示未发生，x₅＝1表示发生
IVH	x₆	x₆＝0表示未发生，x₆＝1表示发生
NEC	x₇	x₇＝0表示未发生，x₇＝1表示发生
真菌感染	x₈	x₈＝0表示未发生，x₈＝1表示发生

表5 极低出生体重早产儿发生支气管肺发育不良的8个并发症的单因素logistic回归分析

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
NRDS	1.723	0.451	14.579	<0.001	5.600	2.313～13.559
PDA	1.284	0.523	6.025	0.014	3.609	1.295～10.059
新生儿肺炎	0.898	0.488	3.383	0.066	2.455	0.943～6.390
败血症	0.908	0.424	3.454	0.032	2.478	1.080～5.685
代谢性酸中毒	0.488	0.479	1.039	0.308	1.629	0.638～4.160
IVH	0.750	0.443	2.867	0.090	2.118	0.888～5.047
NEC	1.174	0.938	1.567	0.211	3.234	0.515～20.317
真菌感染	0.016	0.739	0.000	0.983	1.016	0.238～4.326

表5 极低出生体重早产儿发生支气管肺发育不良的8个并发症的单因素logistic回归分析

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
NRDS	1.723	0.451	14.579	<0.001	5.600	2.313～13.559
PDA	1.284	0.523	6.025	0.014	3.609	1.295～10.059
新生儿肺炎	0.898	0.488	3.383	0.066	2.455	0.943～6.390
败血症	0.908	0.424	3.454	0.032	2.478	1.080～5.685
代谢性酸中毒	0.488	0.479	1.039	0.308	1.629	0.638～4.160
IVH	0.750	0.443	2.867	0.090	2.118	0.888～5.047
NEC	1.174	0.938	1.567	0.211	3.234	0.515～20.317
真菌感染	0.016	0.739	0.000	0.983	1.016	0.238～4.326

表6 极低出生体重早产儿发生支气管肺发育不良的3项危险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
NRDS	1.503	0.475	10.007	0.002	4.497	1.772～11.415
PDA	0.968	0.586	2.726	0.099	2.633	0.834～8.308
败血症	0.925	0.469	3.892	0.049	2.521	1.006～6.319

表6 极低出生体重早产儿发生支气管肺发育不良的3项危险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
NRDS	1.503	0.475	10.007	0.002	4.497	1.772～11.415
PDA	0.968	0.586	2.726	0.099	2.633	0.834～8.308
败血症	0.925	0.469	3.892	0.049	2.521	1.006～6.319

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