Postnatal High-risk Factors And Early Predicition Of Bronchopulmonary Dysplasia Development Of Premature Infants

Objective: This research prospectively studied the clinical data of premature infants and investigates the risk factors of prenatal bronchopulmonary dysplasia(BPD).The dynamic changes of soluble B7-H3(s B7-H3)and interleukin-18(IL-18)in sera of premature infants were detected,and the score of neonatal critical illness score(NCIS)on the day of admission was recorded.Then this study analyzed their prediction effects on BPD to guide clinical prevention and treatment of BPD and improve its conditions of prognosis.Methods: From January 1,2017 to December 31,2017,72 cases of premature children with a hospitalization time that was higher than 28 days and embryonic age that are less than 32 weeks were collected for this prospective study at the neonatal intensive care unit(NICU)at Children’s Hospital of Soochow University.According to the occurrence of BPD,the sample cases were divided into BPD and non-BPD group.Then the following methods were employed.(1)This study collected records of premature infants who were admitted to the hospital at their birth,the general situation of mothers,basic diseases,and complications,the treatment of premature infants during hospitalization,the nutritional status of premature infants.Postnatal high-risk factors of BPD were explored.(2)Enzyme-linked immunosorbent assay(ELISA)was employed to test the levels of s B7-H3 and IL-18 in peripheral blood on day 1,day 7,day 14 and day 28.Meanwhile,NCIS were scored on the day of admission.Receiver operating characteristic(ROC)curve was used to test the significant differences between the BPD and non-BPD groups on indicators of BPD early prediction ability.Logistic regression analysis combined with ROC curve was employed to build BPD early prediction model.Results:First,(1)Among 72 preterm infants,44(61.11%)were males and 28(38.89%)were females,with the birth weight from 740 to 2050 g,and the average birth weight was 1355.56±271.30 g.The gestational ages were 26+3 ~ 32 weeks and the average gestational age was 30.06±1.39 weeks.The BPD group had 30 cases,and the non-BPD group had 42 cases.In BPD group,there were 3 mild cases,22 moderate cases,and 5 severe cases.No significant difference(P>0.05)was found on BPD and non-BPD groups on gender,birth weight,gestational age and situations of mothers in general.(2)There were significant differences(P<0.05)between the two groups in the following aspects: ventilator associated pneumonia(VAP),periventricular intraventricular hemorrhage(PVH-IVH)(III-IV degrees),parenteral nutrition associated cholestasis(PNAC),patent ductus arteriosus(PDA),anemia,retinopathy of prematurity(ROP),electrolyte disturbances,Because of invasive ventilation,the days of inhaled oxygen concentration> 40%,blood transfusion ≥ 3 times,beginning of the intestine within the feeding day,and oral heat card reached 120 kcal / kg.d day age ≥ 40 d.Logistic regression analysis showed that electrolyte imbalance(OR=11.024,95% CI: 2.472~49.167),PDA(OR=28.530,95% CI: 1.915~425.039),oral calorie up to 120 kcal / kg.d & day age≥40d(OR=17.652,95% CI: 2.472~49.167)were high risk factors for postnatal BPD.(3)BPD group had significantly less fluid and caloric intake on day 3,7,14 and 28 after birth than the non-BPD group.On the 7th and 14 th days,BPD group had less the total calorie intake(P<0.05)than that of non-BPD group(P<0.05).There was no significant difference in total fluid intake and body weight gain between the two groups on the 3rd,7th,14 th and 28 th days(P>0.05).Second,the early prediction of BPD in preterm infants:(1)The level of s B7-H3 in BPD group on the 7th,14 th and 28 th day were significantly lower than that on the first day,and the difference was statistically significant(P<0.05).Serum s B7-H3 concentrations were higher than those in the non-BPD group on day 1,7 and 14,but the difference was statistically significant only on the 7th day(P<0.05).(2)On the 7th and 14 th day,the level of serum IL-18 on the 28 th day was significantly higher than that on the first day(P<0.05).The levels of IL-18 in the serum of BPD group were significantly higher than those of the non-BPD group on the 1st day,the 7th day,the 14 th day and the 28 th day(P<0.05).(3)Serum s B7-H3 and IL-18 levels have insignificant difference(P>0.05)within the BPD on the 1st,7th,14 th and 28 th day.(4)The NCIS of BPD group was significantly lower than that of the non-BPD group,and the difference was statistically insignificant(P>0.05).(5)The area under the curve(AUC)values of serum s B7-H3(7d),serum IL-18(14d),NCIS,electrolyte imbalance,PDA,and oral calorie up to 120 kcal / kg.d & day age ≥40d are 0.781,0.694,0.789,0.710,0.621,and 0.769,respectively.The sensitivity values of serum s B7-H3(7d),serum IL-18(14d),NCIS,are 76.70%,73.30%,and 73.30% respectively,with specificity of 73.80%,71.40%,and 81.00% respectively.The AUC of BPD prediction model was constructed by Logistic regression with s B7-H3(7d),IL-18(14d),NCIS,electrolyte imbalance,PDA,and oral calorie up to 120 kcal / kg.d & day age ≥40d.The sensitivity and specificity were 0.960,86.70%,and 97.60% respectively.For the AUC values,sensitivities,and specificity that were higher than each index,they were predicted by alone.Conclusion:(1)electrolyte imbalance,PDA,oral calorie up to 120 kcal / kg.d & day age ≥40d are high-risk factors for BPD and preterm infants BPD in neonatal enteral nutrition was significantly less than non-BPD premature children.(2)The level of serum s B7-H3(7d),serum IL-18(14d),NCIS,electrolyte imbalance,PDA,and oral calorie up to 120 kcal / kg.d & day age ≥40d could better predict the occurrence of BPD but could not predict the severity of BPD in the Logistic model.