Objectives: With the development of perinatal and neonatal intensive care medicine, the survival rate of very premature infants increases year by year. However, the incidence of bronchopulmonary dysplasia (BPD) increases year by year, which seriously affects the survival prognosis of very premature infants. How to prevent and treat BPD effectively has become the focus of neonatologists. This study aims to provide ideas for the prevention and treatment of BPD in very preterm infants via analyzing the clinical characteristics of BPD.
Methods: A total of 472 cases of very premature infants admitted to the Divison of Neonatology, Department of Pediatrics at the Second Xiangya Hospital of Central South University were retrospectively selected and assigned into a BPD group (n=147) and a non-BPD group (n=325) according to the diagnosis of BPD. Clinical data of each group were collected to find out the clinical characteristics of BPD in very preterm infants. Basic information, maternal pregnancy data, laboratory findings, nutritional support, respiratory support patterns and duration, and systemic complications were included.
Results: Compared with the non-BPD group, gestational age, birth weight, head circumference and body length in the BPD group were lower, the Apgar score in 1st min and 5th min and average body weight growth rate were lower (all P<0.05); the ratios of male, very low birth weight (VLBW), and extremely low birth weight (ELBW) in the BPD group were higher than those in the non-BPD group (all P<0.5); the incidence of maternal cervical insufficiency and the rate of using embryo transfer technology in the BPD group were higher than those in the non-BPD group, and the rate of using prenatal hormone in the BPD group was lower than that in the non-BPD group (all P<0.05). The positive rate of sputum culture in the BPD group was higher than that in the non-BPD group (P<0.05), and the white blood cell count, neutrophil ratio, and procalcitonin in the BPD group were higher than those in the non-BPD group (all P<0.05). The period of fasting, minimal feeding, total parenteral nutrition (TPN), and partial parenteral nutrition (PPN) in the BPD group were longer than those in the non-BPD group (all P<0.05). The duration of nasal catheter oxygen inhalation and mechanical ventilation in the BPD group was longer than that in the non-BPD group, and the rates of mechanical ventilation at Day 1, 3, 7, 14, 21 and 28 after birth were higher than those in the non-BPD group (all P<0.05). The incidence of respiratory distress syndrome, apnea of prematurity, respiratory failure, pneumonia, pulmonary hemorrhage, pleural effusion, persistent pulmonary hypertension, hemodynamic patent ductus arteriosus, cytomegalovirus infection, neonatal necrotic enterocolitis, cholestasis, anemia, abnormal blood system, hypothyroidism, retinopathy of prematurity, and internal environment disorders in the BPD group were significantly higher than those in non-BPD group (all P<0.05).
Conclusions: There are significant differences between very premature infants with BPD and those without BPD in general information, maternal history, inflammatory indicators, nutritional support, respiratory support, comorbidities and complication rates. To ensure normal fetal development, reducing the inflammatory reaction of very premature infants, establishing enteral nutrition as early as possible, shortening the time of mechanical ventilation, and reducing the occurrence of complications are beneficial to decrease the incidence of BPD in very premature infants and improve the long-term prognosis of BPD.
目的: 随着围生和新生儿重症医学的发展，极早早产儿的存活率逐年升高，但其支气管肺发育不良(bronchopulmonary dysplasia，BPD)的发病率仍逐年升高，并严重影响极早早产儿的生存预后。如何有效地防治BPD已成为新生儿科医生的关注热点。本研究分析极早早产儿BPD的临床特征，旨在为极早早产儿BPD的防治措施提供参考。方法: 回顾性纳入中南大学湘雅二医院儿科新生儿专科收治的472例极早早产儿，根据最终是否诊断为BPD分为BPD组(n=147)和非BPD组(n=325)。收集2组患儿的基本情况、母孕期资料、实验室检查结果、营养支持情况、呼吸支持模式和持续时间、各系统并发症，并比较2组患儿的临床特征。结果: BPD组的出生胎龄、头围、体重及身长均小于、低于或短于非BPD组(均P<0.05)，1 min及5 min Apgar评分、平均体重增长速度均低于非BPD组(均P<0.05)；男婴、极低出生体重(very low birth weight，VLBW)及超低出生体重(extremely low birth weight，ELBW)比例均高于非BPD组(均P<0.05)；BPD组患儿母亲宫颈机能不全发生率和胚胎移植技术使用率均高于非BPD组，产前激素使用率低于非BPD组(均P<0.05)；BPD组患儿痰培养阳性率高于非BPD组(P<0.05)，白细胞计数、中性粒细胞比值及降钙素原均高于非BPD组(均P<0.05)；BPD组患儿禁食时间、微量喂养时间、全肠外营养(total parenteral nutrition，TPN)及部分肠外营养(partial parenteral nutrition，PPN)时间均长于非BPD组(P<0.05)；BPD组患儿鼻导管吸氧和机械通气使用时间长于非BPD组，出生后第1、3、7、14、21、28天机械通气使用率均高于非BPD组(均P<0.05)；BPD组呼吸窘迫综合征、呼吸暂停、呼吸衰竭、肺炎、肺出血、胸腔积液、持续肺动脉高压、有血流动力学意义的动脉导管未闭、巨细胞病毒感染、新生儿坏死性小肠结肠炎、胆汁淤积、贫血、病理性黄疸、血液系统异常、甲状腺功能减低、早产儿视网膜病变，以及内环境紊乱发病率均高于非BPD组(均P<0.05)。结论: 患有BPD的极早早产儿在基本情况、母孕期病史、炎症指标水平、营养支持、呼吸支持、合并症及并发症发生率方面与未患BPD的极早早产儿均存在明显差异。确保胎儿正常发育，减轻极早早产儿的炎症反应，尽早建立肠内营养，缩短机械通气时间，降低合并症及并发症的发生率有利于降低极早早产儿BPD发生率及改善BPD远期预后。.
Keywords: bronchopulmonary dysplasia; clinical characteristics; very preterm infants.