Analysis Of Risk Factors Of Brain Injury In Premature Infants With BPD

Objective:To analyse the risk factors of premature brain injury in children with bronchopulmonary dysplasia of premature infants,so as to provide a basis for the early prevention and treatment of premature brain injury,and provide a new idea for clinical evaluation of neurodevelopmental prognosis in patients with BPD.Methods:A retrospective cohort study was conducted in this study.Preterm infants with gestational age of 32 weeks or birth weight<1500g who were admitted to the Department of Neonatology of the First Affiliated Hospital of Anhui Medical University from February 2020 to March 2022 were included in the study.Magnetic resonance imaging(MRI)was performed at or near term and magnetic resonance imagin was scored according to the imaging findings.The scoring criteria refer to the eight-item scoring system of magnetic resonance imaging evaluation,which is used as the judgment index of early brain injury.White matter score≥7 or gray matter score≥5 were regarded as MRI positive(MRI~+)group,others as MRI negative(MRI~-)group.The clinical characteristics of the two groups were compared,the risk factors of early brain injury in children with BPD were analyzed,and the predictive value of the indexes for brain injury was evaluated by receiver operating characteristic curve(ROC).Results:A total of 122 premature infants with BPD were included in this study.34 cases were in MRI positive group and 88 cases were in MRI negative group.There were no significant differences in birth weight、Apgar score at 1 min、cesarean section、twins or multiple births、premature rupture of membranes、amniotic fluid contamination、gestational diabetes mellitus、pregnancy induced hypertension、prenatal hormone use、septicemia、PDA and the lowest platelet count in the course of disease between the two groups.There were significant differences in male、gestational age、Apgar score at 5minutes、total oxygen time、mechanical ventilation time、peak procalcitonin and hearing impairment between the two groups(p<0.05).Logistic regression model suggested that Apgar score(or=0.506,95%CI:0.271.0.948,P=0.033),duration of mechanical ventilation(or=1.008,95%CI:1.001-1.016,P=0.025)and hearing impairment(OR=0.025,95%CI:0.001.0.700,P=0.030)were independent risk factors for brain injury in children with BPD.Apgar score at 5 minutes、mechanical ventilation duration and hearing impairment were predictive of brain injury in premature infants with BPD.The optimal cut-off values were 0.167,810.00 h and 0.522,respectively,the predicted Sensitivity and specificity were 41.2%and 100%,64.7%and 89.2%,76.5%and75.7%,respectively.Conclusions:Apgar score,duration of mechanical ventilation and hearing damage were associated with brain damage in premature infants with BPD,and has some predictive value for brain injury in children with BPD.Early positive recovery should be used in clinical work.For premature infants with BPD,we should identify the high risk factors of brain injury early,reduce the time of mechanical ventilation and intervene early to improve the prognosis.