| Objective: To study the occurrence and high risk factors of related extrapulmonary complications in premature infants with bronchopulmonary dysplasia(BPD),and try to provide a predictive value for clinical reference by calculating cumulative supplemental oxygen exposure(CSO).Methods: This article is a retrospective case-control study,including 405 premature infants with gestational age <32 weeks and birth weight <1500g who were diagnosed and treated in the First Neonatal Ward of Shengjing Hospital of China Medical University from January 2020 to December 2022 According to clinical diagnosis,they were divided into control group(206 cases),mild BPD group(128 cases)and moderate to severe BPD group(71 cases).The general data at birth,the main treatment measures after birth,and the occurrence of premature infant-related complications in the three groups were retrospectively analyzed,including white matter injury(WMI),retinopathy of prematurity(ROP),metabolic Metabolic bone disease of prematurity(MBDP)and CSO were calculated,and then based on the presence or absence of each complication,children with BPD were divided into groups with or without WMI,ROP,and MBDP.Difference analysis and multivariate logistic regression were used to analyze BPD The risk factors of patients with extrapulmonary complications were obtained,and the corresponding predictive indicators were obtained.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic performance of the predictive indicators and obtain the cut-off value.Results:(1)General data: there were significant differences in gestational age,birth weight,asphyxia,use of multiple doses(two or more doses)of PS,patent ductus arteriosus,sepsis,cumulative oxygen therapy time and invasive mechanical ventilation time among the three groups.(2)There was significant difference in the incidence of ROP and MBDP among the three groups.The probability of WMI,ROP and MBDP in moderate and severe BPD group was significantly higher than that in mild BPD group.(3)Univariate analysis showed that gestational age and birth weight,asphyxia,late-onset sepsis,cumulative oxygen therapy time,invasive mechanical ventilation time and CSO were significantly correlated with ROP in children with BPD.Gestational age,birth weight,late-onset sepsis,cumulative oxygen therapy time,invasive mechanical ventilation time and CSO were significantly correlated with MBDP in children with BPD.(4)In multivariate logistic regression analysis,1-28CSO(OR=2.042,95%CI:1.102～3.783,P=0.023)and oxygen therapy time(OR=1.044,95%CI:1.009～1.080,P=0.012)were independent risk factors for ROP in children with BPD.1-28CSO(OR=2.124,95%CI:1.193～3.784,P=0.011),birth weight(OR=0.040,95%CI:0.005～0.352,P=0.004)and late-onset sepsis(OR=2.165,95%CI:1.027～4.567,P=0.042)were independent risk factors for MBDP in children with BPD.(5)The results of ROC curve analysis show that 1-28 CSO has predictive value for BPD combined with ROP and MBDP,among which the prediction effect for combined ROP is the best,with an area under the curve(AUC)=0.872(P<0.001),a cutoff value of 2.9,a sensitivity of 70.8% and a specificity of 88.2%.Conclusion:(1)The probability of BPD complicated with ROP and MBDP was higher than that of non-BPD premature infants,and the probability of moderate and severe BPD group complicated with WMI,ROP and MBDP was higher than that of mild BPD group.(2)Gestational age,birth weight,cumulative time of oxygen therapy,time of invasive mechanical ventilation,history of asphyxia and late-onset sepsis are high risk factors for extrapulmonary complications(ROP and MBDP)in children with BPD.(3)The cumulative supplemental oxygen exposure at 28 days after birth has a high predictive value in the early assessment of BPD combined with ROP and MBDP,providing a theoretical basis for its further clinical application. |
