Risk factors and prognosis analysis of bronchopulmonary dysplasia in preterm small for gestational age infants

doi:10.3877/cma.j.issn.1673-5250.2024.02.012

Objective

To investigate influencing factors and prognosis of bronchopulmonary dysplasia (BPD) in preterm small for gestational age (SGA) infants.

Methods

A total of 92 preterm (gestational age of 24-32 weeks) SGA infants who were hospitalized in Neonatal Intensive Care Unit (NICU) of Affiliated Hospital of Qingdao University from January 2019 to December 2021 were selected as study subjects. Using a retrospective cohort study method, they were divided into BPD group (n=38) and BPD-free group (n=54) according to whether BPD was diagnosed at 36 weeks′ corrected gestational age or not. The clinical data, treatment and BPD related complications of preterm SGA infants between two groups were statistically compared by chi-square test, independent samples t test and Mann-Whitney U test. Multivariate unconditional logistic regression analysis was used to analyze the independent influencing factors of BPD in preterm SGA infants. This study was approved by the Medical Ethics Committee of our hospital (Approval No. QYFY WZLL 28257), and the guardians of all subjects gave informed consent to diagnosis and treatment and signed an informed consent form for this clinical study.

Results

① The body weight at 1 month after birth, birth length and head circumference, Apgar score at 1 min and 5 min after birth of preterm SGA infants in BPD group were lower, shorter and smaller than those in BPD-free group, while invasive mechanical ventilation, noninvasive mechanical ventilation, oxygen inhalation and hospitalization time, and the utilization rate of pulmonary surfactant (PS) were longer, higher than those in BPD-free group, and all the differences were statistically significant (P<0.01). ② The results of multivariate unconditional logistic regression analysis showed that the long duration of non-invasive mechanical ventilation (OR=1.180, 95%CI: 1.064-1.308, P=0.002) and the long duration of oxygen inhalation after birth (OR=1.295, 95%CI: 1.126-1.488, P<0.001) were independent risk factors for BPD in preterm SGA infants. ③ The incidences of pneumonia, late-onset sepsis, hemodynamically significant patent ductus arteriosus (hsPDA) and retinopathy of prematurity (ROP) in the BPD group were higher than those in the BPD-free group, and the differences were statistically significant (P<0.05).

Conclusion

For preterm SGA infants, the timing of non-invasive mechanical ventilation and oxygen inhalation should be appropriately controlled to reduce the incidence of BPD and related complications.

Key words: Bronchopulmonary dysplasia, Infant, small for gestational age, Risk factors, Retinopathy of prematurity, Ductus arteriosus, patent, Infant, premature

表1 2组早产SGA儿临床资料比较

组别	例数	母亲
组别	例数	自然受孕[例数(%)]	顺产[例数(%)]	产前感染[例数(%)]	年龄(岁，±s)	妊娠期高血压疾病[例数(%)]	妊娠期糖尿病[例数(%)]	产前使用激素[例数(%)]
BPD组	38	37(97.4)	4(10.5)	13(34.2)	32.8±4.1	24(63.2)	6(15.8)	37(97.4)
无BPD组	54	53(98.1)	0(0)	18(33.3)	32.8±4.8	35(64.8)	11(20.4)	47(87.0)
统计量		－^a	－^a	χ²＝0.01	t＝0.03	χ²＝0.03	χ²＝0.31	－^a
P值		>0.999	0.026	0.930	0.979	0.870	0.577	0.134
组别	例数	生后1个月体重(g，±s)	男性[例数(%)]	单胎[例数(%)]	出生身长(cm，±s)	出生头围(cm，±s)	生后1 min Apgar评分[分，M(Q₁，Q₃)]	生后5 min Apgar评分[分，M(Q₁，Q₃)]
BPD组	38	1 332±279	24(63.2)	26(68.4)	34.5±2.8	25.4±2.2	6.5(5.0，8.0)	8.0(7.0，9.0)
无BPD组	54	1 549±255	29(53.7)	47(87.0)	36.5±3.0	26.9±2.0	8.0(7.0，9.0)	9.0(8.0，10.0)
统计量		t＝3.87	χ²＝0.82	χ²＝4.72	t＝3.34	t＝3.28	Z＝4.32	Z＝3.61
P值		<0.001	0.366	0.030	0.001	0.001	<0.001	<0.001
组别	例数	出生时血小板计数[×10⁹/L，M(Q₁，Q₃)]	出生时Hb水平[g/L，M(Q₁，Q₃)]	有创机械通气时间[d，M(Q₁，Q₃)]	无创机械通气时间[d，M(Q₁，Q₃)]	面罩/鼻导管/箱内吸氧时间[d，M(Q₁，Q₃)]	开奶时间[d，M(Q₁，Q₃)]	静脉营养时间[d，M(Q₁，Q₃)]
BPD组	38	180(154，196)	171(160，182)	0(0，4)	35.5(18.0，52.0)	24(8，35)	1(1，2)	28.5(22.0，41.0)
无BPD组	54	189(156，218)	178(163，191)	0(0，0)	10.0(6.0，20.0)	0(0，4)	1(1，2)	25.0(18.0，32.0)
统计量		Z＝0.96	Z＝1.69	Z＝3.94	Z＝5.32	Z＝6.36	Z＝0.71	Z＝2.03
P值		0.339	0.092	<0.001	<0.001	<0.001	0.478	0.021
组别	例数	全胃肠营养时间[d，M(Q₁，Q₃)]	输血[例数(%)]	使用PS[例数(%)]	PS剂量[mg，M(Q₁，Q₃)]	住院时间[d，M(Q₁，Q₃)]	父亲年龄[岁，M(Q₁，Q₃)]
BPD组	38	29.5(23.0，42.0)	32(84.2)	18(47.4)	0(0，220)	75.5(61.0，97.0)	33(30，39)
无BPD组	54	26.0(19.0，33.0)	34(63.0)	11(20.4)	0(0，0)	54.0(47.0，65.0)	33(30，37)
统计量		Z＝2.19	χ²＝4.97	χ²＝7.53	Z＝2.53	Z＝4.93	Z＝0.24
P值		0.029	0.026	0.006	0.011	<0.001	0.814

表1 2组早产SGA儿临床资料比较

组别	例数	母亲
组别	例数	自然受孕[例数(%)]	顺产[例数(%)]	产前感染[例数(%)]	年龄(岁，±s)	妊娠期高血压疾病[例数(%)]	妊娠期糖尿病[例数(%)]	产前使用激素[例数(%)]
BPD组	38	37(97.4)	4(10.5)	13(34.2)	32.8±4.1	24(63.2)	6(15.8)	37(97.4)
无BPD组	54	53(98.1)	0(0)	18(33.3)	32.8±4.8	35(64.8)	11(20.4)	47(87.0)
统计量		－^a	－^a	χ²＝0.01	t＝0.03	χ²＝0.03	χ²＝0.31	－^a
P值		>0.999	0.026	0.930	0.979	0.870	0.577	0.134
组别	例数	生后1个月体重(g，±s)	男性[例数(%)]	单胎[例数(%)]	出生身长(cm，±s)	出生头围(cm，±s)	生后1 min Apgar评分[分，M(Q₁，Q₃)]	生后5 min Apgar评分[分，M(Q₁，Q₃)]
BPD组	38	1 332±279	24(63.2)	26(68.4)	34.5±2.8	25.4±2.2	6.5(5.0，8.0)	8.0(7.0，9.0)
无BPD组	54	1 549±255	29(53.7)	47(87.0)	36.5±3.0	26.9±2.0	8.0(7.0，9.0)	9.0(8.0，10.0)
统计量		t＝3.87	χ²＝0.82	χ²＝4.72	t＝3.34	t＝3.28	Z＝4.32	Z＝3.61
P值		<0.001	0.366	0.030	0.001	0.001	<0.001	<0.001
组别	例数	出生时血小板计数[×10⁹/L，M(Q₁，Q₃)]	出生时Hb水平[g/L，M(Q₁，Q₃)]	有创机械通气时间[d，M(Q₁，Q₃)]	无创机械通气时间[d，M(Q₁，Q₃)]	面罩/鼻导管/箱内吸氧时间[d，M(Q₁，Q₃)]	开奶时间[d，M(Q₁，Q₃)]	静脉营养时间[d，M(Q₁，Q₃)]
BPD组	38	180(154，196)	171(160，182)	0(0，4)	35.5(18.0，52.0)	24(8，35)	1(1，2)	28.5(22.0，41.0)
无BPD组	54	189(156，218)	178(163，191)	0(0，0)	10.0(6.0，20.0)	0(0，4)	1(1，2)	25.0(18.0，32.0)
统计量		Z＝0.96	Z＝1.69	Z＝3.94	Z＝5.32	Z＝6.36	Z＝0.71	Z＝2.03
P值		0.339	0.092	<0.001	<0.001	<0.001	0.478	0.021
组别	例数	全胃肠营养时间[d，M(Q₁，Q₃)]	输血[例数(%)]	使用PS[例数(%)]	PS剂量[mg，M(Q₁，Q₃)]	住院时间[d，M(Q₁，Q₃)]	父亲年龄[岁，M(Q₁，Q₃)]
BPD组	38	29.5(23.0，42.0)	32(84.2)	18(47.4)	0(0，220)	75.5(61.0，97.0)	33(30，39)
无BPD组	54	26.0(19.0，33.0)	34(63.0)	11(20.4)	0(0，0)	54.0(47.0，65.0)	33(30，37)
统计量		Z＝2.19	χ²＝4.97	χ²＝7.53	Z＝2.53	Z＝4.93	Z＝0.24
P值		0.029	0.026	0.006	0.011	<0.001	0.814

表2 早产SGA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
生后1个月体重(连续变量)	0.003	0.004	0.477	0.490	1.003	0.995～1.011
1 min Apgar评分(连续变量)	0.099	0.518	0.037	0.848	1.104	0.400～3.049
5 min Apgar评分(连续变量)	－0.089	0.619	0.020	0.886	0.915	0.272～3.081
出生身长(连续变量)	0.119	0.222	0.287	0.592	1.126	0.729～1.740
出生头围(连续变量)	0.367	0.348	1.112	0.292	1.443	0.730～2.853
有创机械通气(连续变量)	0.825	0.545	2.288	0.130	2.281	0.784～6.642
无创机械通气(连续变量)	0.165	0.053	9.850	0.002	1.180	1.064～1.308
面罩/鼻导管/箱内吸氧(连续变量)	0.258	0.071	13.175	<0.001	1.295	1.126～1.488
住院时间(连续变量)	0.005	0.067	0.005	0.946	1.005	0.881～1.145
使用PS(vs未使用)	－1.760	1.515	1.348	0.246	0.172	0.009～3.355
常数项	－25.596	16.523	2.400	0.121	<0.001	－

表2 早产SGA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
生后1个月体重(连续变量)	0.003	0.004	0.477	0.490	1.003	0.995～1.011
1 min Apgar评分(连续变量)	0.099	0.518	0.037	0.848	1.104	0.400～3.049
5 min Apgar评分(连续变量)	－0.089	0.619	0.020	0.886	0.915	0.272～3.081
出生身长(连续变量)	0.119	0.222	0.287	0.592	1.126	0.729～1.740
出生头围(连续变量)	0.367	0.348	1.112	0.292	1.443	0.730～2.853
有创机械通气(连续变量)	0.825	0.545	2.288	0.130	2.281	0.784～6.642
无创机械通气(连续变量)	0.165	0.053	9.850	0.002	1.180	1.064～1.308
面罩/鼻导管/箱内吸氧(连续变量)	0.258	0.071	13.175	<0.001	1.295	1.126～1.488
住院时间(连续变量)	0.005	0.067	0.005	0.946	1.005	0.881～1.145
使用PS(vs未使用)	－1.760	1.515	1.348	0.246	0.172	0.009～3.355
常数项	－25.596	16.523	2.400	0.121	<0.001	－

表3 2组早产SGA儿并发症发生率比较[例数(%)]

组别	例数	感染性肺炎	贫血	新生儿低血糖	肠外营养相关性胆汁淤积症	晚发败血症	NRDS
BPD组	38	30(78.9)	38(100.0)	2(5.3)	7(18.4)	13(34.2)	38(100.0)
无BPD组	54	14(25.9)	54(100.0)	4(7.4)	12(22.2)	6(11.1)	53(98.1)
χ²值		25.13	－^a	－^a	0.20	7.26	－^a
P值		<0.001	>0.999	>0.999	0.657	0.007	>0.999
组别	例数	hsPDA	肺动脉高压	ROP	NEC	喂养不耐受
BPD组	38	23(60.5)	8(21.1)	14(36.8)	2(5.3)	5(13.2)
无BPD组	54	17(31.5)	4(7.4)	7(13.0)	3(5.6)	12(22.2)
χ²值		7.66	2.56	7.22	－^a	1.22
P值		0.006	0.110	0.007	>0.999	0.270

表3 2组早产SGA儿并发症发生率比较[例数(%)]

组别	例数	感染性肺炎	贫血	新生儿低血糖	肠外营养相关性胆汁淤积症	晚发败血症	NRDS
BPD组	38	30(78.9)	38(100.0)	2(5.3)	7(18.4)	13(34.2)	38(100.0)
无BPD组	54	14(25.9)	54(100.0)	4(7.4)	12(22.2)	6(11.1)	53(98.1)
χ²值		25.13	－^a	－^a	0.20	7.26	－^a
P值		<0.001	>0.999	>0.999	0.657	0.007	>0.999
组别	例数	hsPDA	肺动脉高压	ROP	NEC	喂养不耐受
BPD组	38	23(60.5)	8(21.1)	14(36.8)	2(5.3)	5(13.2)
无BPD组	54	17(31.5)	4(7.4)	7(13.0)	3(5.6)	12(22.2)
χ²值		7.66	2.56	7.22	－^a	1.22
P值		0.006	0.110	0.007	>0.999	0.270

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