A Multicenter Clinical Study On The Relationship Between Nutrition And Fluid Management Within 2 Weeks After Birth With Bronchopulmonary Dysplasia In Very Preterm Infants

Objective:To analyze the characteristics of nutritional and fluid management and its relat ionship with bronchopulmonary dysplasia(BPD)of very preterm infants in neonata l intensive care units(NICU)of four hospitals in Shandong province within 2 wee ks after birth.Methods:The basic information of very preterm infants with gestational age less than 32 weeks who were born between January 1,2020 and December 31,2020 in four hospitals were collected.Depending on whether BPD occurs,neonates were divided into BPD group and non-BPD group.According to the severity of BPD,the neonates were divided into grade I BPD group,grade II BPD group and grade III BPD group.The characteristics of nutrition and fluid management within 2 weeks after birth were retrospectively analyzed.T/U test or Chi-square test were used to compare nutritional and fluid management differences between BPD and non-BPD groups and between BPD subgroups with different severity.Multivariate binary logistic regression analysis was used to investigate the relationship between nutritional and fluid management and the occurrence of BPD in very preterm infants within 2 weeks after birth.Results:A total of 208 children were enrolled in this study,including 153 in the nonBPD group and 55 in the BPD group(31 in the grade I BPD group,17 in the g rade II BPD group,and 7 in the grade III BPD group).1.Compared with non-BPD group,the gestational age,birth weight,birth head circumference,birth length,5min and 10 min Apgar scores and usage rates of prenatal hormones were less in BPD group,while the incidences of birth asphyxia,pulmonary surfactant and early-onset sepsis of the BPD group were higher,the time of invasive ventilation and non-invasive ventilation time in the BPD group was longer(All P values<0.05).2.The intake of protein and calories on days 0-7 were less in the BPD group than those in the non-BPD group(All P values <0.05).The intake of protein,fat and calories on days 8-14 were also less in the BPD group than those in the non-BPD group(All P values <0.05).The enteral fluid on days 0-7 and 8-14 were lower in BPD group compared with the non-BPD group,while the amount of parenteral fluid on days 8-14,the amount of total fluid on days 0-7 and 8-14 were higher(All P values<0.05).The average Vit D intake of the first 14 days was lower in the BPD group than those in the non-BPD group,while the sodium intake of the BPD group was higher than the non-BPD group during the first 14 days(All P values <0.05).3.Multivariate binary logistic regression analysis showed that invasive mechanical ventilation time,non-invasive mechanical ventilation time and the total fluid i ntake on days 0-7 were independent risk factors for BPD in very preterm infants.Birth weight,protein and calorie intakes on days 8-14 were protective factors for BPD in very preterm infants.4.There were statistically significant differences in gestational age,prenatal hormone,birth asphyxia,early-onset sepsis and invasive mechanical ventilation time in grade I,II and III BPD groups(All P values <0.05).There were no statistically significant differences in the intake of protein,fat,carbohydrate and calorie on 0-7 days and 8-14 days in grade I,II and III BPD groups(All P values > 0.05).There were statistically significant differences in enteral fluid,parenteral fluid intake and total fluid intake on days 0-7 between the three groups(All P values <0.05).The Duration of invasive mechanical ventilation was independent risk factor for moderate to severe BPD in very preterm infants.Conclusion:1.The occurrence of BPD in very preterm infants was the result of the joint action of multiple factors.Limiting total fluid intake from day 0 to 7,and increasing protein and calorie intake from day 8 to 14 could help reduce the incidence of BPD in very preterm infants.2.On the basis of reasonable nutrition and fluid management,optimizing mechanical ventilation strategy and shortening the duration of invasive mechanical ventilation can reduce the incidence of moderate to severe BPD in very preterm infants.