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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2023, Vol. 19 ›› Issue (06): 675 -682. doi: 10.3877/cma.j.issn.1673-5250.2023.06.008

Original Article

Correlation of patent ductus arteriosus with bronchopulmonary dysplasia in very low birth weight preterm infants

Quanxiu Tian1, Aimin Han1, Yan Xu1,†()   

  1. 1. Department of Neonatology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • Received:2023-10-17 Revised:2023-11-20 Published:2023-12-01
  • Corresponding author: Yan Xu
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Objective

To investigate the correlation between the shunt direction and duration of patent ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD) in preterm infants with very low birth weight(VLBW).

Methods

From January 2020 to June 2023, a total of 193 PDA VLBW preterm infants with birth gestational age <32 weeks and birth weight (BW)<1 500 g who were hospitalized in the Affiliated Hospital of Xuzhou Medical University, were enrolled into this study. Using retrospective analysis method, they were divided into 3 groups based on the echocardiographic results after 7 d of birth: the nhsPDA (non-hemodynamically significant PDA) group (n=89), the hsPDA-lr (hemodynamically significant PDA left to right shunt) group (n=65) and the hsPDA-rl/bd (hemodynamically significant PDA right to left/bidirectional shunt) group (n=39). The general clinical data, complication incidence rates and therapeutic effect among 3 groups of PDA VLBW preterm infants were statistically compared. Independent risk factors affecting the development of BPD and BPD (grades 2-3) in these PDA VLBW preterm infants were analyzed by single-factor and multivariate unconditional logistic regression analysis. The study was approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (Approval No. XYFY2022-KL302-01), and informed consents were obtained from all guardians of premature infants.

Results

① Compared to PDA VLBW preterm infants in nhsPDA group, PDA VLBW preterm infants in hsPDA-lr group and hsPDA-rl/bd group were all younger in birth gestational age, had lower BW, had higher proportions of infants with birth gestational age ≤28 weeks, tracheal intubation within 24 h, use of pulmonary surfactant (PS), use of vasoactive drugs, use of ibuprofen, PDA shunt duration ≥7 d, BPD, BPD (grades 2-3), intracranial hemorrhage (IVH) (≥grade 3) and retinopathy of premature (ROP), all differences were statistically significant (P<0.05). ② Compared to PDA VLBW preterm infants in hsPDA-lr group, infants in hsPDA-rl/bd group had younger birth gestational age, lower BW, had higher proportions of infants with birth gestational age ≤28 weeks, pulmonary haemorrhage, use of vasoactive drugs, and longer duration of mechanical ventilation, and all differences were statistically significant (P<0.05). ③ Multivariate unconditional logistic regression analysis showed that PDA shunt duration ≥7 d (OR=2.500, 95%CI: 1.121-5.572, P=0.025; OR=3.395, 95%CI: 1.195-9.646, P=0.022) were independent risk factors for the development of BPD and BPD (grades 2-3) of PDA VLBW preterm infants.

Conclusions

The risk of developing BPD and BPD (grades 2-3) in VLBW preterm infants was increased after PDA shunt duration ≥7 d. Early refined management of PDA VLBW preterm infants is clinically significant to evaluate the risk and for the prevention and treatment of BPD.

Key words: Infant, very low birth weight, Ductus arteriosus, patent, Bronchopulmonary dysplasia, Echocardiography, doppler, color, Infant, premature
表1 3组PDA VLBW早产儿孕母临床资料比较[例数(%)]
组别 例数 多胎妊娠 妊娠期高血压疾病 妊娠期糖尿病 胎膜早破 产前使用激素 剖宫产术分娩
nhsPDA组 89 12(13.5) 37(41.6) 13(14.6) 24(27.0) 63(70.8) 63(70.8)
hsPDA-lr组 65 12(18.5) 31(47.7) 12(18.5) 16(24.6) 36(55.4) 54(83.1)
hsPDA-rl/bd组 39 5(12.8) 12(30.8) 12(30.8) 11(28.2) 25(64.1) 27(69.2)
χ2值   0.92 2.88 4.60 0.19 3.88 3.74
P值   0.633 0.237 0.100 0.911 0.144 0.154
表2 3组PDA VLBW早产儿临床资料比较
组别 例数 男性[例数(%)] 出生胎龄[周，M(Q1，Q3)] 出生胎龄≤28周[例数(%)] BW(g，±s) 小于胎龄儿[例数(%)] 生后5 min Apgar评分<5分[例数(%)]
nhsPDA组 89 52(58.4) 30.5(29.6，31.6) 4(4.5) 1 377±294 5(5.6) 9(10.1)
hsPDA-lr组 65 40(61.5) 29.8(28.5，30.6)a 10(15.4)a 1 208±316a 6(9.2) 13(20.0)
hsPDA-rl/bd组 39 20(51.3) 28.1(27.4，30.1)a，b 19(48.7)a，b 1 159±297a，b 2(5.1) 6(15.4)
统计量   χ2＝1.06 Z＝30.96 χ2＝37.62 F＝9.60 χ2＝0.98 χ2＝2.99
P值   0.588 <0.001 <0.001 <0.001 0.612 0.224
组别 例数 24 h内气管插管[例数(%)] PS使用[例数(%)] 肺出血[例数(%)] 血管活性药物使用[例数(%)] 布洛芬使用[例数(%)] PDA分流时间≥7 d [例数(%)] 机械通气时间[d，M(Q1，Q3)]
nhsPDA组 89 58(65.2) 57(64.0) 2(2.2) 8(9.0) 0(0) 39(36.7) 5(0，10)
hsPDA-lr组 65 54(83.1)a 53(81.5)a 5(7.7) 28(43.1)a 38(58.5)a 53(81.5)a 11(7，16)
hsPDA-rl/bd组 39 37(94.9)a 35(89.7)a 10(25.6)a，b 31(79.2)a，b 28(71.8)a 36(92.3)a 19(10，28)a，b
统计量   χ2＝15.52 χ2＝11.74 χ2＝18.63 χ2＝62.49 χ2＝87.76 χ2＝48.05 Z＝50.28
P值   0.003 0.003 <0.001 <0.001 <0.001 <0.001 <0.001
组别 例数 PN时间[d，M(Q1，Q3)] BPD[例数(%)] BPD(2～3级)[例数(%)] IVH(≥3级)[例数(%)] NEC(≥Ⅱ期)[例数(%)] ROP[例数(%)]
nhsPDA组 89 16(11，25) 27(30.3) 21(23.6) 3(3.4) 2(2.2) 3(3.4)
hsPDA-lr组 65 20(15，29) 42(64.6)a 34(52.3)a 9(13.8)a 1(1.5) 12(18.5)a
hsPDA-rl/bd组 39 22(16，35)a 31(79.5)a 26(66.7)a 6(15.4)a 3(7.7) 13(33.3)a
统计量   Z＝12.45 χ2＝32.62 χ2＝24.96 χ2＝7.00 χ2＝3.47 χ2＝20.86
P值   0.002 <0.001 <0.001 0.030 0.176 <0.001
表3 193例PDA VLBW早产儿发生BPD的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
出生胎龄≤28周(vs 28～32周) 1.514 0.723 4.381 0.036 4.544 1.101～18.753
24 h内气管插管(vs 24 h内无气管插管) 0.364 0.550 0.437 0.508 1.439 0.490～4.225
PS使用(vs未使用) 0.729 0.521 1.958 0.162 2.073 0.747～5.755
肺出血(vs未发生) 1.472 0.878 2.810 0.094 4.357 0.780～24.348
血管活性药物使用(vs未使用) －0.140 0.479 0.085 0.770 0.869 0.340～2.224
PDA分流方向(vs nhsPDA)            
hsPDA-lr 0.747 0.422 3.137 0.077 2.112 0.923～4.829
hsPDA-rl/bd 0.751 0.632 1.411 0.235 2.119 0.614～7.316
PDA分流时间≥7 d(vs <7 d) 0.916 0.409 5.018 0.025 2.500 1.121～5.572
IVH≥3级(vs未发生或<3级) 2.323 1.100 4.459 0.035 10.205 1.182～88.130
ROP(vs未发生) 1.157 0.714 2.630 0.105 3.181 0.786～12.880
常数项 －2.251 0.488 21.312 <0.001 0.105 —
表4 193例PDA VLBW早产儿发生BPD(2～3级)的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
出生胎龄≤28周(vs 28～32周) 0.960 0.777 1.529 0.216 2.612 0.570～11.972
24 h内气管插管(vs 24 h内无气管插管) 0.147 0.583 0.064 0.801 1.158 0.370～3.629
血管活性药物使用(vs未使用) －0.812 0.589 1.898 0.168 0.444 0.140～1.410
布洛芬使用(vs未使用) 1.154 0.632 3.334 0.068 3.170 0.919～10.937
机械通气时间(连续变量) 0.175 0.039 20.595 <0.001 1.191 1.104～1.285
PDA分流方向(vs nhsPDA)            
hsPDA-lr －0.517 0.615 0.706 0.401 0.596 0.179～1.992
hsPDA-rl/bd －0.527 0.766 0.472 0.492 0.591 0.132～2.652
PDA分流时间≥7 d(vs<7 d) 1.222 0.533 5.263 0.022 3.395 1.195～9.646
ROP(vs未发生) 1.792 0.872 4.227 0.040 6.002 1.087～33.132
常数项 －3.356 0.621 29.191 <0.001 0.035 —
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