| Objective: With the progress of perinatal management,the survival rate of extremely preterm infants(EPI)born at a gestational age of less than 28 weeks has increased significantly,and these preterm infants have extremely immature lung structures and poor repair ability after injury,which are the main reasons for the increasing incidence of bronchopulmonary dysplasia(BPD).There is no systematic report on the clinical characteristics of BPD in ultra-premature infants,especially severe BPD(s BPD)in China.The purpose of this study was to understand the clinical characteristics of BPD in hospitalized ultra-premature infants and to investigate the risk factors for s BPD.Method:A single-center retrospective cohort analysis of ultra-premature infants admitted to the Second Neonatal Unit of Shengjing Hospital of China Medical University from January 2012 to December 2021 was conducted to collect maternal gestational and neonatal data,and compare maternal gestational and neonatal characteristics,neonatal treatment history and outcome,respectively.To understand the clinical characteristics of BPD in ultra-premature infants,we compared the differences in clinical data of each group according to whether BPD occurred and its degree,and applied logistic multiple regression analysis to explore the risk factors of severe BPD.Results: During the same period,319 cases were hospitalized with EPI,220 cases met the inclusion criteria,and 193 cases were diagnosed with BPD.the mean gestational age(GA)of the BPD group was 27w(24-27w),the mean birth weight(BW)was 944g(498-1389g),117 cases(60.6%)were male,76 cases(39.4%),43 cases(22.3%)with mild,88 cases(45.6%)with moderate,and 62 cases(32.1%)with severe BPD.There were 27 cases of non-BPD,GA 26-27 w,BW 754g-1350 g,14 males(51.8%)and 13females(48.2%).1 The incidence of BPD(84.9%,88.9%,100% and 100%)and s BPD to corresponding gestational age ratio(25.4%,37.5%,42.9% and 83.3%)in EPI increased gradually with decreasing gestational age)gradually increased,and the incidence of GA27 w BPD was significantly lower than that of those with gestational age 24-25w(P <0.05).2.Compared with the non-BPD group,the BPD group had significantly lower incidence of assisted reproductive techniques(33.2% vs 11.1%),use of tracheal intubation in the delivery room(64.2% vs 33.3%),application of PS(81.9% vs 63%),caffeine(79.8% vs 59.3%)and glucocorticoids(44.6% vs 3.7%)were significantly higher;mean invasive ventilation(24d vs 4d),non-invasive ventilation(27d vs 15d)and duration of oxygen therapy(72d vs 58d)were longer,mean birth weight(944g vs 1013g)and 1-minute Apgar score were lower(6 vs 7),PDA for surgical treatment(17.1% vs 0)and ectopic growth restriction(80.3% vs 63%)were higher,and mean PMA(38w vs 36w)and length of stay(82d vs 65d)at discharge were significantly greater than in the non-BPD group,with all differences statistically significant(P < 0.05).3.Compared with the mild and moderate BPD group,the mean GA(26w vs 27w)and BW(862g vs 982g)were significantly lower;intubation in the delivery room(72.6% vs 60.3%),glucocorticoid and PS application rate(67.7% vs 33.6%;90.3% vs 77.9%),mean invasive ventilation time(48d vs 12d),surgically treated PDA(33.9% vs 9.3%)and NEC(12.9% vs 4.6%),late onset sepsis(56.5% vs 30.5%),and treated ROP(48.4% vs 9.9%)were significantly increased;mean length of stay(96d vs 75d)and mean PMA at discharge(40w vs 37w)were prolonged,and the proportion of home oxygen therapy(50% vs 16%)and ectopic growth restriction(88.7% vs 76.3%)Significantly increased,with statistically significant differences in all comparisons(P < 0.05).4.Multifactorial logistic regression analysis showed that birth weight(OR=0.995,95%CI:0.992-0.999),gestational hypertension(OR=4.126,95%CI:1.176-14.479)and duration of invasive ventilation(OR= 1.090,95%CI:1.051-1.130)were risk factors for s BPD,and the area under the ROC curve for invasive ventilation time prediction was 0.868(95%CI:0.815-0.92),with a critical value of 29.5 days,specificity 0.786 and sensitivity0.806.Conclusion: The incidence of BPD and the proportion of s BPD in EPI increased significantly with decreasing gestational age;the number of surface active substance applications,the duration of invasive ventilation,the duration of glucocorticoid application and the corrected gestational age at discharge for severe BPD increased significantly,and the incidence of complications in preterm infants increased significantly;the duration of invasive ventilation longer than 29.5 days predicted the occurrence of severe BPD. |
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