The Predictive Value Of Respiratory Severity Score And Oxygenation Index In Bronchopulmonary Dysplasia In Very Low Birth Weight Infant

Objective Bronchopulmonary dysplasia is a common and serious chronic lung disease in premature infants.It has become a challenging problem in the management of premature infants because of its complex pathogenesis,high treatment cost,long cycle and easy to leave neurological sequelae.In order to early predict the occurrence of bronchopulmonary dysplasia in VLBWI,early prevent and treat children with high-risk factors of bronchopulmonary dysplasia,and reduce the occurrence of bronchopulmonary dysplasia,the purpose of this study is to explore the value o f respiratory severity score combined with oxygenation index in predicting bronchopulmonary dysplasia in very / ultra-low birth weight infants.Methods The clinical data of very low birth weight preterm infants who were born in the obstetrics department o f the First Affiliated Hospital of Anhui Medical University from November 2016 to November 2020 and transferred to Neonatal Intensive Care unit and needed endotracheal intubation and mechanical ventilation for more than 12 hours were analyzed retrospective ly.The respiratory severity score and oxygenation index of initial mechanical respiration at admission were calculated respectively.The children were divided into BPD group and non BPD group.The gestational age,birth weight,gender,Apgar score,test tube baby,multiple births,delivery mode,pregnancy complications,pregnancy induced hypertension syndrome,placental abruption,premature rupture of membranes,gestational diabetes mellitus,antenatal glucocorticoid,Magnesium Sulfate and mechanical ventilation days were compared between the two groups.The difference of RSS score and oxygenation index at the beginning of mechanical ventilation;Logistic regression analysis was used to analyze the influencing factors of bronchopulmonary dysplasia.The rece iver operating characteristic curve（ROC）evaluated the predictive value of the two indexes and the combination of the two indexes.Results 72 newborns met the inclusion conditions were devided into two groups,40 in BPD group and 32 in non BPD group;The results of univariate score showed that there were significant differences in gestational age,birth weight,proportion of prenatal use of glucocorticoids,proportion of cesarean section,days of mechanical ventilation,respiratory severity score at the beginning of mechanical ventilation and oxygenation index between the two groups（P < 0.05）.The average gestational age and birth weight of children in BPD group were（28.09 ± 1.38）weeks and（1068.00 ± 206.95）g,while those in non BPD group were（30.35 ± 1.16）weeks and（1205.60 ± 211.35）g;6 cases（15.00%）in BPD group and 14 cases（43.8%）in non BPD group used glucocorticoids before delivery.In the BPD group,there were 22 cesarean sections（55.00%）,while in the non BPD group,there were 7 cesarean s ections（21.9%）.The number of days of mechanical ventilation in BPD group was 8.50（5.00,14.25）days,while that in non BPD group was 5.00（3.00,6.00）days;In BPD group,RSS and oxygenation index were4.50（3.66,7.15）points and 92.00（64.00151.00）mm Hg respectively;RSS and oxygenation index of non BPD group were 2.80（2.10,3.43）points and 249.00（115.50,341.75）mm Hg,respectively.There was no significant difference in gender,Apgar score,IVF,multiple births,pregnancy complications and intrapart um application of magnesium sulfate（P ≥ 0.05）.Logistic regression analysis showed that there was significant difference in RSS and oxygenation index between the two groups（P < 0.05）,suggesting that RSS and oxygenation index are risk factors of BPD.The receiver operating characteristic curve（ROC）showed that The AUC of RSS score predicting bronchopulmonary dysplasia was 0.931（sensitivity 95.0%,specificity 75.0%）,the AUC of oxygenation index predicting BPD was 0.891（sensitivity 95.0%,specificity 71.9%）,and the AUC of RSS score combined with oxygenation index predicting bronchopulmonary dysplasia was 0.957（sensitivity 85.0%,specificity 96.9%）.Conclusion RSS and oxygenation index are independent risk factors for bronchopulmonary dysplasia.The combina tion of the two may have a certain predictive value for bronchopulmonary dysplasia in very low birth weight infants.