| Objective:Clinical data of premature infants with gestational age≤32 weeks were collected prospectively to analyze and explore the postnatal risk factors of bronchopulmonary dysplasia（BPD）,and to explore the correlation between early echocardiographic tricuspid regurgitation velocity and BPD.The concentration of N-terminal-pro-B-brain natriuretic peptide（NT-Pro BNP）in premature infants within 24 hours after birth was detected to analyze the correlation between NT-Pro BNP and BPD among them.Finally,to explore the effect of early prediction of related indexes on occurrence of BPD in premature infants using multivariate analysis,so as to guide the clinical prevention of BPD and improve the prognosis of premature infants.Methods:From October 1,2018 to February 29,2020,the premature infants transferred to the neonatal intensive care unit（NICU）of the Children’s Hospital of Soochow University within24 hours after birth and with gestational age≤32 weeks were prospectively studied.According to the occurrence of BPD,premature infants were divided into two groups:BPD group and non-BPD group.Among the premature infants without BPD,those whose general data has no difference with that of BPD group were randomly considered as non-BPD group.The data of admission,pregnancy,underlying diseases,complications during hospitalization,treatment measures,laboratory examination when admission and nutritional status within 28days were recorded,and the postnatal risk factors of BPD were analyzed.The results of echocardiography within 24 hours after admission were analyzed to explore the correlation between tricuspid regurgitation velocity and occurrence of BPD.The serum NT-Pro BNP concentration of the two groups of premature infants within 24 hours after birth were measured by electrochemiluminescence immunoassay to compare the different degrees of BPD between the two groups.The receiver operator characteristic curve（ROC）was used to evaluate the efficacy of early prediction by tricuspid regurgitation velocity,NT-Pro BNP and postnatal risk factors of BPD,and to further combine with multi-index Logistic regression analysis to construct the early prediction model of BPD.Results:1.Comparison of the general conditions of the two groups of premature infants:During the study period,a total of 232 premature infants with gestational age≤32 weeks were treated in our center,12 cases who discharged automatically,32 cases who hospitalized for less than 28 days,15 cases who underwent surgical operation during hospitalization were excluded.Among them,40 cases developed BPD,while among those without BPD,42 cases whose general data has no difference with that of BPD group were randomly considered as non-BPD group.A total of 82 premature infants（50 males and 32 females）were selected,with the average gestational age of（30.15±0.91weeks）and the average birth weight of（1372.87±193.38）g.In BPD group,there were 40 cases in total（25 males;62.50%）,with the average gestational age of（29.96±1.10）weeks and the average birth weight of（1353±198.18）g.In non-BPD group,there were 42 cases in total（25 males）,with the average gestational age of（30.34±0.06）weeks and the average birth weight of（1410±196.75）g.There were 19 cases of mild BPD,15 cases of moderate BPD and 6 cases of severe BPD in BPD group.There was no significant difference in gender,gestational age,birth weight,history of asphyxia,whether to be premature infant,whether to be test-tube baby,whether to be twin or multiple births between the two groups（P>0.05）.2.Collection and comparison of the clinical data of premature infants and their mothers:（1）Comparison of the general conditions of mothers of two groups of premature infants:maternal age,gravida,parity,delivery method,premature rupture of fetal membrane≥18hours,use of prenatal hormones,abruptio placentae,placenta previa,gestational diabetes,gestational hypertension,preeclampsia,amniotic fluid contamination,oligohydramnios,gestational anemia,prenatal infection and maternal underlying diseases,there were no significant difference between the two groups（P>0.05）.（2）Comparison of underlying diseases and complications between the two groups:In the BPD group,ventilator associated pneumonia（VAP）,feeding intolerance,parenteral nutrition-associated cholestasis（PNAC）,brain injury in premature infants（BIPI）,periventricular-intraventricular hemorrhage（PVH-IVH）,frequent apnea,septicemia,extrauterine growth retardation（EUGR）and retinopathy of prematurity（ROP）were significantly higher than non-BPD group（P<0.05）.While there were no significant difference in the occurrence rate of neonatal respiratory distress syndrome（NRDS）,neonatal pneumonia,pneumothorax,suppurative meningitis,pulmonary hemorrhage and necrotizing enterocolitis（NEC）between the two groups（P>0.05）.（3）Comparison of treatment measures between the two groups during hospitalization:the use rate of caffeine,albumin and gamma globulin,invasive ventilation time,non-invasive ventilation time,number of days with Fi O2≥40%,oxygen inhalation time,erythrocyte suspension infusion volume（ml/kg）,the time of achieving total enteral nutrition>24 days and invasive ventilation time>7 days in BPD group were significantly higher than those in non-BPD group（P<0.05）.（4）Comparison of laboratory examination between the two groups when admission:the concentrations of hemoglobin,hematocrit and albumin in BPD group were significantly lower than those in non-BPD group（P<0.05）.There were no significant difference in white blood cell count,red blood cell count,platelet count,mean red blood cell volume,red blood cell distribution width,neutrophil absolute value,lymphocyte absolute value,platelet mean volume,platelet distribution width and prealbumin concentration between the two groups（P>0.05）.（5）Comparison of nutrition management between the two groups:the time of starting enteral feeding and achieving total enteral feeding in BPD group were later than that in non-BPD group（P<0.05）.The oral fluid intake and calorie intake on the 3rd,7th,14th,21st and 28th day after birth in BPD group were significantly lower than those in non-BPD group（P<0.05）.The venous fluid intake and calorie intake on the 7th,14th,21st and 28th day after birth in BPD group was significantly higher than that in non-BPD group（P<0.05）.The total calorie intake on the 3rd,7th and 14th day after birth in BPD group were significantly lower than non-BPD group（P<0.05）.There were no significant difference in total liquid intake on the 3rd,7th,14th,21st and 28th day after birth,intravenous calorie intake on the 3rd day after birth,and total calorie intake on the 21st and 28th day after birth between the two groups（P>0.05）.3.Analysis of independent risk factors of BPD in premature infants:Logistic regression analysis showed that:VAP（OR=14.443,95%CI:1.045～199.522）,number of days with Fi O2≥40%（OR=0.664,95%CI:1.047～3.608）,red blood cell suspension infusion volume（ml/kg）（OR=1.108,95%CI:1.044～1.175）and the time of achieving total enteral nutrition>24 days（OR=7.683,95%CI:1.320～44.714）were independent risk factors for postnatal BPD in premature infants.4.Comparison of the results of echocardiography between the two groups:（1）The incidences of patent ductus arteriosus（PDA）and pulmonary hypertension（PH）in BPD group were significantly higher than those in non-BPD group[65%（26/40）VS 14.3%（6/42）,27.5%（11/40）VS 2.4%（1/42）,both P<0.05].There were no significant difference in the incidence of patent foramen ovale（PFO）,atrial septal defect（ASD）,ventricular septal defect（VSD）,ejection fraction（EF）and left ventricular shortening fraction（FS）between the two groups[35%（14/40）VS.33.3%（14/42）,67.5%（27/40）VS.66.7%（28/40）,0 VS.0,70.16±6.84 VS.67.74±4.90,36.84±5.26 VS.34.95±3.59,all P>0.05].（2）The proportion of tricuspid regurgitation in BPD group was significantly higher than that in non-BPD group,and the tricuspid regurgitation velocity（m/s）in BPD group was significantly higher than that in non-BPD group.（3）The faster the tricuspid regurgitation velocity,the higher the incidence and severity of BPD,Spearman correlation analysis showed that there was a positive correlation between tricuspid regurgitation velocity and the severity of BPD（r=0.388,P<0.05）.（4）The area under the curve（AUC）of tricuspid regurgitation velocity to predict the occurrence of BPD was 0.735.When the tricuspid regurgitation velocity was1.45m/s,the sensitivity was 88.1%and the specificity was 62.5%..5.Comparison of NT-Pro BNP between the two groups:（1）The serum NT-Pro BNP concentration at 24 hours after birth in BPD group was significantly higher than that in non-BPD group[4610.5（3102.3,11403.5）pg/ml VS.1928.9（1207,3472.5）pg/ml,P<0.05].The serum NT-Pro BNP concentration in the severe BPD premature infants was significantly higher than those in the mild and moderate BPD premature infants[15851（6389,34400）pg/ml VS.4029（2257,8770）pg/ml,15851（6389,34400）pg/ml VS.4173（2883,9496）pg/ml,all P<0.05].There was no difference in serum NT-Pro BNP concentrations between mild and moderate BPD premature infants[4029（2257,8770）pg/ml VS.4173（2883,9496）pg/ml,P>0.05].（2）The higher the level of NT-Pro BNP,the higher the incidence and more severity of BPD,Spearman correlation analysis showed that there was a positive correlation between NT-Pro BNP（pg/ml）and the severity of BPD（r=0.543,P<0.05）.（3）The AUC for predicting the occurrence of BPD at NT-Pro BNP concentration was 0.802.When the concentration of NT-Pro BNP was 2688.3pg/ml,the sensitivity was 69%and the specificity was 80%.6.Early prediction of BPD in premature infants:The AUCs of ROC curve analysis of tricuspid regurgitation velocity（m/s）,NT-Pro BNP（pg/ml）,VAP,number of days with Fi O2≥40%,red blood cell suspension infusion volume（ml/kg）,the time of achieving total enteral nutrition>24 days for predicting the occurrence of BPD were 0.735,0.802,0.638,0.846,0.903,0.780,respectively.The sensitivities of tricuspid regurgitation velocity,NT-Pro BNP,number of days with Fi O2≥40%and red blood cell suspension infusion volume were 88.1%,69%,85.7%and 88.1%,respectively;the specificity were 62.5%,80%,87.5%and 85%,respectively,which can be used for early prediction of BPD.Tricuspid regurgitation velocity,NT-Pro BNP,VAP,number of days with Fi O2≥40%,red blood cell suspension infusion volume and the time of achieving total enteral nutrition>24 days combined with Logistic regression were used to build the BPD prediction model,with AUC of 0.986,sensitivity of92.9%and specificity of 97.5%,which was significantly higher than that predicted by the above indicators alone.Conclusion:（1）VAP,number of days with Fi O2≥40%,red blood cell suspension infusion volume（ml/kg）and the time of achieving total enteral nutrition>24 days were high-risk factors for postnatal BPD in premature infants with gestational age≤32 weeks.（2）The incidence and velocity of tricuspid regurgitation in BPD group were both significantly higher than those in non-BPD group,and tricuspid regurgitation velocity was positively correlated with the severity of BPD.When tricuspid regurgitation velocity>1.45m/s,the risk of BPD increased.（3）The serum NT-Pro BNP concentration in BPD group was significantly higher than that in non-BPD group within 24 hours after birth,and its concentration increased with the severity of BPD,and NT-Pro BNP concentration（pg/ml）was positively correlated with the severity of BPD.When NT-Pro BNP>2688.3pg/ml,the risk of BPD increased.（4）The construction of combined regression model with tricuspid regurgitation velocity,NT-Pro BNP,VAP,number of days with Fi O2≥40%,red blood cell suspension infusion volume and the time of achieving total enteral nutrition>24 days can better predict the occurrence of BPD. |
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