| Objective:Through the analysis and follow-up of clinical data of premature infants with bronchopulmonary dysplasia(BPD),to explore the clinical high risk factors of BPD in different degrees and the clinical outcome of glucocorticoid therapy for BPD and its effect on cognitive and brain development of premature infants,so as to guide clinical prevention and treatment of BPD.Methods:Part one:Analysis of high risk factors for different degrees of bronchopulmonary dysplasia in premature infantsBPD infants who were admitted to the neonatal intensive care unit(NICU),gestational age<32 weeks,birth weight<2000 g and hospitalization days>28 days were selected as the study subjects within 24 hours after birth from May 1,2015 to November 30,2018.(1)The subjects were divided into two groups:mild BPD group(using oxygen for more than 28 days,correcting gestational age 36 weeks without oxygen inhalation or not using oxygen at discharge)and moderate/severe BPD group(using oxygen for more than 28 days,correcting gestational age 36 weeks with oxygen inhalation or still using oxygen at discharge).(2)To compare and analyze the prenatal maternal status,the general information of premature infants,the main diseases,complications,related treatment and clinical outcome during hospitalization between the two groups.(3)Receiver operating characteristic curve(ROC)was drawn to analyze and compare the predictive effectiveness of the indicators with statistical differences between the two groups for moderate/severe BPD.Logistic regression analysis combined with ROC curve was used to construct moderate/severe BPD prediction model.Part two:The effect of glucocorticoid therapy on clinical outcome of premature infants with bronchopulmonary dysplasiaBPD infants who were admitted to the neonatal intensive care unit(NICU),gestational age<32 weeks,birth weight<2000 g and hospitalization days>28 days were selected as the study subjects within 24 hours after birth from May 1,2015 to November 30,2018.(1)According to use of glucocorticoid after diagnosis of BPD,they were divided into hormone group and non-hormone group.(2)To compare and analyze the prenatal maternal status,the general information of premature infants,the main diseases,complications,related treatment and clinical outcome during hospitalization between the two groups.(3)Five time periods of corrected gestational age(1-3 months,3-6 months,6-12 months,12-24 months and 24-42 months)were followed up,and the physical development(including weight,length or height),five energy region development quotient of Gesell Development Scale and results of cranial magnetic resonance imaging were compared between the two groups.Results:Part one:From May 1,2015 to November 30,2018,there were 1648 premature infants hospitalized in NICU,261 premature infants with BPD.The incidence of BPD in NICU was 15.8%.131 cases met the inclusion criteria,69 cases with mild BPD(52.7%)and 62 cases with moderate/severe BPD(47.3%).(1)The comparative analysis of clinical data between the two groups showed that the following statistics were differences between mild BPD group and moderate/severe BPD group:gestational age,admission age,small for gestational age infant,preeclampsia or eclampsia,premature infants with parenteral nutrition associated cholestasis(PNAC),pulmonary hypertension,retinopathy of premature infants(ROP),invasive ventilation days,continuous positive airway pressure(CPAP)days,total days of oxygen inhalation,total days of antibiotic use,time of lactation,times of blood transfusion,days of hospitalization,hospitalization expenses,oral liquid volume on the 3rd day after birth,oral liquid volume and intravenous liquid on the 21st and 28th day after birth(P<0.05).(2)Multivariate logistic regression analysis showed that small for gestational age infant(OR=3.826,95%CI:1.029～14.229),PNAC(OR=7.418,95%CI:1.856～29.649),pulmonary hypertension(OR=5.238,95%CI:1.147～23.917),CPAP days(OR=1.033,95%CI:1.001～1.066)were independent risk factors for moderate/severe BPD.(3)The areas under the curve of predicting moderate/severe BPD for small for gestational age infant,PNAC,pulmonary hypertension and CPAP days were 0.600(95%CI:0.502～0.698),0.591(95%CI:0.493～0.690),0.583(95%CI:0.484～0.682),0.629(95%CI:0.533～0.726),and the area under the ROC curve of the four combined logistic regression models was 0.776,sensitivity was 67.7%,specificity was 84.1%.All of them were higher than those predicted by the four indices alone.Part two:A total of 121 premature infants with BPD met the inclusion criteria,53 in hormone group and 68 in non-hormone group.(1)Comparison of clinical datas between hormone group and non-hormone group:There was no significant difference in the prenatal maternal status,the general information of premature infants,the main diseases and complications between the two groups(P>0.05);invasive ventilation days,CPAP days,total days of oxygen inhalation,proportion of diuretics used,total days of antibiotic use,proportion of fluconazole used,times of blood transfusion,days of hospitalization,hospitalization expenses in hormone group were significantly higher than those in non-hormone group(P<0.05).(2)The distribution of BPD in different degrees between the two groups was compared:There were 19(35.8%)cases of mild BPD and 34(64.2%)cases of moderate/severe BPD in hormone group.There were 43(63.2%)cases of mild BPD and 25(36.8%)cases of moderate/severe BPD in non-hormone group.The proportion of moderate/severe BPD in hormone group was significantly higher than that in non-hormone group(P<0.05).(3)A total of 121 patients in the two groups were assessed with Gesell Development Scale.There were 53 cases in hormone group and 68 cases in non-hormone group.Distribution was in the corrected age range of 1-3 months,3-6 months,6-12 months,12-24 months and 24-42 months.There was no significant difference in BPD severity,follow-up weight and body length among those who completed follow-up at all ages between the two groups(P>0.05).In the follow-up group of 1-3 months,the levels of fine exercise,physical ability,verbal ability,and energetic ability in hormone group were lower than those in non-hormone group(P<0.05),and there was no significant difference in gross exercise between the two groups(P>0.05).In the follow-up group of 3-6 months and 6-12 months,the fine exercise and physical ability in hormone group were lower than those in non-hormone group(P<0.05),and there was no significant difference in gross exercise,verbal ability,and energetic ability between the two groups(P>0.05).In the follow-up group of 12-24 months and 24-42months,the fine exercise in hormone group were lower than those in non-hormone group(P<0.05),and there was no significant difference in gross exercise,physical ability,verbal ability,and energetic ability between the two groups(P>0.05).(4)A total of 110 cases completed the first cranial magnetic resonance after birth,of which 51 cases completed at the corrected age of 32-36 weeks and 59 cases completed at the corrected age of 36-44 weeks.A total of 27 patients completed the second cranial magnetic resonance at the corrected age of 1-6 months.There were no significant differences in the corrected gestational age,the number of cases with thin cerebral cortex,cerebellar volume and BPD degree between the two groups who completed the first cranial magnetic resonance at the corrected age of 32-36 and 36-44 weeks(P>0.05).There was no significant difference in the corrected age,the number of cases with thin cerebral cortex,cerebellar volume and BPD degree between the two groups who completed the second cranial magnetic resonance at the corrected age of 1-6 months(P>0.05).Conclusion:Part one:The incidence of BPD in NICU preterm infants was 15.8%;The incidence of mild BPD was higher than that of moderate/severe BPD;small for gestational age infant,PNAC,pulmonary hypertension and CPAP days were independent risk factors for moderate/severe BPD;The combined forecasting of four indicators is better than the single forecasting of four indicators for the occurrence of moderate/severe BPD.Part two:l.Compared with the non-hormone group,the hormone group had more severe BPD,more severe infection,longer aerobic time and higher cost.2.Hormone therapy has no adverse effect on the physical development of BPD premature infants,but has adverse effect on fine exercise,physical ability,verbal ability and energetic ability.The most obvious manifestation is in 1-3 months.3.Hormone therapy may have no adverse effect on cortical thickness and cerebellar volume of BPD premature infants within 6 months. |
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