Correlation Between Early Nutrition And Bronchopulmonary Dysplasia In Preterm Infants

Objective: To explore the correlation between early nutrition and bronchopulmonary dysplasia(BPD)in preterm infants with gestational age < 32 weeks,hoping to provide theoretical reference for early nutrition strategies in children with high risk of BPD.Methods: A retrospective case-control study was conducted.The subjects were premature infants with gestational age < 32 weeks who were admitted to the neonatal intensive care unit(NICU)of the Affiliated Hospital of Youjiang Medical College for Nationalities from December 2016 to December 2021.A total of 195 preterm infants meeting the criteria were included.According to the clinical diagnosis and classification criteria,they were divided into 46 BPD groups(33 cases in grade I group and 13 cases in grade II / III group)and149 non BPD groups.The general data at birth of the BPD group and the non BPD group were compared.In order to reduce bias,BPD group and non BPD group were grouped according to gestational age < 29 weeks,29 ～ 30 weeks,30 ～ 31 weeks and 31 ～ 32 weeks,and the non BPD group was numbered.Starting from any row or column in the random number table,read3 digits as the random number of the corresponding number,and arrange them according to the size of the random number.Those with the same number of cases and small random number as the gestational age group of BPD group were selected as the control group.The milk opening time,nutrition intake on the 7th and 14 th day in BPD group,control group,grade I group and grade II / III group were analyzed.Results: A total of 195 premature infants met the inclusion criteria,including 122 males(62.6%)and 73 females(37.4%);Among them,18 cases(9.2%)had GA < 28 weeks,32 cases(16.4%)had GA at 28 ～ 29 weeks,35 cases(17.9%)at 29 ～ 30 weeks,59 cases(30.3%)at 30～ 31 weeks and 51 cases(26.2%)at 31 ～ 32 weeks;There were 16 cases(8.2%)with birth weight(BW)less than 1000 g,126 cases(64.6%)with birth weight ranging from 1000 to1500 g,and 53 cases(27.2%)with birth weight greater than 1500 g.There were 46 cases in BPD group(35 males,accounting for 76.1%),including 12 cases(26.1%)with GA < 28 weeks,5 cases(10.9%)with GA < 28 weeks,7 cases(15.2%)with GA < 29 weeks,10 cases(21.7%)with GA < 30 weeks,and 12 cases(26.1%)with GA < 31 weeks;BW < 1000 g in 12 cases(75.0%),1000 ～ 1500 g in 25 cases(19.8%),and > 1500 g in 9 cases(17.0%).In the non BPD group,there were 149 cases(86 males,accounting for 57.7%),including 6 cases(4.0%)with GA < 28 weeks,27 cases(18.1%)with GA < 28 weeks,28 cases(18.8%)with GA < 28 weeks,49 cases(32.9%)with GA < 30 weeks,and 39 cases(26.2%)with GA < 31 weeks;BW <1000g in 4 cases(2.7%),1000 ～ 1500 g in 101 cases(67.8%),and > 1500 g in 44 cases(29.5%).(2)Single factor analysis of general data between BPD group and non BPD group showed that there were significant differences in male proportion,BW and GA(P < 0.05);There was no significant difference in small for gestational age infants,cesarean section,multiple pregnancies,prenatal hormone use,premature rupture of membranes,asphyxia and maternal hypertension(P > 0.05);Multivariate logistic regression analysis showed that male(OR:2.403,95%CI:1.074 ～ 5.378,P=0.033),GA(OR:1.588,95%CI:1.135 ～ 2.222,P=0.007),BW(OR:2.075,95%CI:1.095 ～ 3.931,P=0.025)were independent risk factors for BPD in preterm infants.(3)Single factor analysis showed that there was no significant difference in general data at birth between BPD group and control group(P > 0.05);BPD group had less milk,lower calorie,lower total amino acid,lower total fat emulsion and lower total carbohydrate on the 7th day,and less milk,higher total / venous amino acid,higher venous fat emulsion and higher venous carbohydrate on the 14 th day.There were significant differences between the two groups(P < 0.05);In BPD group,there was no significant difference in fluid volume,intravenous amino acid,intravenous fat emulsion,intravenous carbohydrate on the7 th day,total calorie,fluid volume,total fat emulsion and total carbohydrate on the 14 th day(P > 0.05);Multivariate logistic regression analysis showed that the opening time(OR:0.965,95%CI:0.933 ～ 0.999,P=0.043)was the protective factor of BPD in preterm infants.(4)Single factor analysis of early nutritional intake in grade ⅰ group and grade ⅱ / ⅲgroup showed that the intravenous carbohydrate in grade I group was low on the 7th day,and the calorie,total amino acid,total fat emulsion and total carbohydrate were low on the 14 th day.There were significant differences between the two groups(P < 0.05);There was no significant difference between the two groups in milk opening time,milk volume,calorie,liquid volume,total / intravenous amino acid,total / intravenous fat emulsion,total carbohydrate on the 7th day,milk volume,liquid volume,intravenous amino acid,intravenous fat emulsion,intravenous carbohydrate on the 14 th day(P > 0.05).Conclusion:(1)Male,low birth age and low birth weight will increase the risk of BPD in preterm infants,and early milk opening can reduce the risk of BPD in preterm infants.(2)high calorie,amino acid,fat emulsion and carbohydrate intake within one week after birth are conducive to the prevention and treatment of BPD.(3)Relying on intravenous nutrition for preterm infants is not conducive to the prevention and treatment of BPD,so they should transition to total gastrointestinal nutrition as soon as possible.