High Risk Factors Analysis And Early Prediction Of Bronchopulmonary Dysplasia In Preterm Infants

PurposeBronchopulmonary dysplasia(BPD)is a common respiratory complication in preterm infants.It is an important cause of poor prognosis in preterm infants,and its incidence is significantly increased with the decrease of gestational age at birth.With the improvement of medical technology and nursing quality,the survival rate of preterm infants with small gestational age increases year by year,but the number of BPD patients also increases year by year.BPD patients are dependent on oxygen and ventilator,and survivors may suffer from pulmonary dysfunction,even pulmonary heart disease,neurodevelopmental delay and other sequelae.Therefore,early prediction and prevention of BPD is one of the key points in the management of complications in preterm infants.Neonatal critical score has the advantages of inexpensive,non-invasive and rapid evaluation of the poor prognosis of neonatal diseases,and has been widely used at home and abroad.In this study,by analyzing the risk factors of BPD in preterm infants with gestational age<32 weeks,the factors with the most predictive value for the occurrence of BPD were obtained,and the early predictive value of the three neonatal critical scores for the occurrence of BPD was explored,so as to provide clinical guidance for the prevention of the occurrence of BPD and the improvement of the prognosis of BPD patients.MethodClinical data of 155 preterm infants with gestational age<32 weeks who were admitted to the Neonatology Department of the First Affiliated Hospital of Shantou University Medical College between January 2015 to March 2019 were collected.In this study,all patients were grouped or graded according to the definition of BPD proposed by the National Institute of Child Health and Human Development and other institutions in 2018.Clinical data of all patients were collected,including general information,maternal conditions,treatment measures during hospitalization,and other complications of preterm infants.At the same time,we calculated the score for neonatal acute physiology-Ⅱ(SNAP-Ⅱ),clinical risk index for babies-Ⅱ(CRIB-Ⅱ)and neonatal critical illness score(NCIS)respectively.Statistical software STATA15.1 was used for data analysis.All clinical data were represented by classified variables or numerical variables,and the variables were compared between groups according to the types of variables byX~2 test,Fisher’s exact test,t test or nonparametric test,and the variables with P<0.2 in univariate analysis were included in stepwise forward Logistic regression.Receiver operator characteristic curve(ROC)was used to evaluate the efficacy of high-risk factors and three neonatal critical scores in early prediction of BPD.Results1.The incidence of BPD in preterm infants with gestational age<32 weeks was 22.58%(35/155).The BPD group included 29 patients withⅠgrade BPD,4 patients withⅡgrade BPD,and 2 patients withⅢgrade BPD,with the constituent ratios of 82.86%(29/35),11.43%(4/35),and 5.71%(2/35).2.Among preterm infants with gestational age<32 weeks,the non-BPD group and the BPD group in gestational age,birth weight,1-minute Apgar score,oxygen index(Pa O2/Fi O2)at admission,p H value at admission,whether inhalation oxygen concentration≥40%,nasal continuous positive airway pressure(n CPAP)duration,invasive mechanical ventilation duration,the times and total amount of red blood cell suspension,duration of antibiotic use and neonatal pneumonia,periventricular-intraventricular hemorrhage rate and other aspects of comparison,the difference was statistically significant(P<0.05).The stepwise Logistic regression analysis showed that oxygenation index(OR=0.993,95%CI:0.987～0.998)was a protective factors for the occurrence of BPD in preterm infants with gestational age<32 weeks,while respiratory frequency at admission(OR=1.055,95%CI:1.011～1.101),duration of n CPAP(OR=1.167,95%CI:1.094～1.245)and total amount of red blood cell suspension(OR=1.015,95%CI:1.006～1.024)were the risk factors for the occurrence of BPD in preterm infants with gestational age<32 weeks.3.Among the preterm infants with gestational age<32 weeks,there was a statistically significant differences in CRIB-Ⅱscores between the non-BPD group and the BPD group(P<0.05),while there was no statistically significant difference in NCIS scores and SNAP-Ⅱscores between the two groups(P>0.05).The area under the curve of SNAP-Ⅱscore,CRIB-Ⅱscore,NCIS score,oxygenation index,respiratory frequency at admission,duration of n CPAP and total amount of red blood cell suspension for predicting the occurrence of BPD in preterm infants with gestational age<32 weeks were 0.589,0.653,0.594,0.692,0.587,0.750,0812,respectively,the best cutoff points were 0 points,4 points,94 points,228.8,52 times/min,13 day,75.81 ml/kg,respectively.The sensitivity and specificity of CRIB-Ⅱfor predicting the occurrence of BPD were 91.40%and 31.70%.Conclusion1.Among the preterm infants with gestational age<32 weeks,low oxygenation index,more respiratory frequency at admission,long duration of n CPAP and more total amount of red blood cell suspension transfusion suggest that infants are more likely to develop BPD.2.Duration of n CPAP and the total amount of red blood cell suspension infusion have high predictive value for the occurrence of BPD in preterm infants with gestational age<32 weeks,while the three neonatal critical scores,oxygenation index and respiratory frequency have low predictive value for the occurrence of BPD.