To Analyze The Risk Factors For Bronchopulmonary Dysplasia And Its Severity In Preterm Infants And To Construct A Prediction Model

Objective:To explore the risk factors of bronchopulmonary dysplasia(BPD)and its severity by analyzing the clinical data of infants and their mothers,and to construct an early risk prediction model,in order to reduce the incidence and severity of BPD,and to provide a basis for early identification of infants at high risk of BPD and severe BPD.Methods:Clinical data of preterm infants with gestational age < 32 w and birth weight ≤1500g admitted to the neonatal intensive care Unit of the First Affiliated Hospital from January 2017 to December 2022 were collected.1)According to the diagnostic criteria of BPD in 2018,the infants were divided into non-BPD group(n=118)and BPD group(n=67),and the two groups were compared in terms of general conditions,perinatal conditions of mothers,treatment measures,and complications.Univariate analysis and multivariate Logistic regression analysis were used to screen out the independent risk factors for BPD.According to the independent risk factors,a prediction model for the risk of BPD was constructed and visualized as a nomogram.The area under the receiver operating characteristic curve and calibration curve were used to evaluate the discrimination and calibration of the model.2)According to the BPD classification criteria in 2018,67 infants with BPD were divided into non-severe BPD group(26cases of grade Ⅰ and 17 cases of grade Ⅱ)and severe BPD group(23 cases of grade Ⅲ and 1 case of grade ⅢA).The general conditions,perinatal conditions,treatment measures and complications of the two groups were compared.Univariate analysis and multivariate Logistic regression analysis were used to identify independent risk factors for severe BPD,and a prediction model for the risk of severe BPD was constructed and evaluated.Results:1.A total of 185 infants were included in this study to analyze the incidence and severity of BPD.The results showed that: The incidence of BPD was 36.21%(67/185),and the incidence of severe BPD was 12.97%(24/185).The incidence rates of BPD and severe BPD in infants with GA < 28 w were 86.36%(19/22)and 59.09%(13/22),respectively,which were significantly higher than those in infants with GA of 28-29+6w and 30-31 +6w(P < 0.001).The incidence rates of BPD and severe BPD in infants with birth weight < 1000 g were 96.77%(30/31)and 54.83%(17/31),respectively,which were significantly higher than those in infants with birth weight of 1000-1249 g and 1250-1500 g(P < 0.001).2.Study the influencing factors of BPD,and the results show that: Acute chorioamnionitis(β=2.144,OR=8.536),red blood cell transfusion(β=0.603,OR=1.828)and invasive mechanical ventilation ≥7 days(β=1.166,OR=3.210)were independent risk factors for BPD.Greater gestational age(β=-0.937,OR=0.392)was a protective factor for BPD(P < 0.05).A prediction model for the risk of BPD was established based on the above four influencing factors:The formula was logit(P)=In [P/(1-P)] =-0.937× gestational age +2.144× acute chorioamnionitis +0.603× red blood cell transfusion +1.166× invasive mechanical ventilation ≥7 days +24.962The AUC of the prediction model was 0.936 > 0.75(95%CI: 0.903-0.970).The AUC after calibration was 0.911 > 0.75(95%CI: 0.899-0.933),indicating that the model had good discrimination.The calibration curve showed that the model was well calibrated.3.To investigate the influencing factors for the severity of BPD,the results showed that: The number of red blood cell transfusion(β=0.472,OR=1.603)and FiO2≥40% for more than 7 days(β=1.910,OR=6.754)were independent risk factors for severe BPD.Higher birth weight(β=-0.005,OR=0.995)was a protective factor for severe BPD.A prediction model for the risk of early severe BPD was established based on the above three influencing factors:The formula was logit(P)=In [P/(1-P)] =-0.005× birth weight +0.472× number of red blood cells transfused +1.91×FiO2≥40% for more than 7 days +2.43The AUC of the prediction model was 0.893 > 0.75(95%CI: 0.815-0.971).The AUC after calibration was 0.880 > 0.75(95%CI: 0.851-0.897),indicating that the model had good discrimination.The calibration curve showed that the model was well calibrated.Conclusions:1.The lower the gestational age and birth weight,the higher the incidence and severity of BPD.2.Gestational age,acute chorioamnionitis,number of red blood cell transfusion and invasive mechanical ventilation ≥7 days are the main influencing factors of BPD.The early risk prediction model of BPD based on the above factors has good discrimination and calibration.3.birth weight,the number of red blood cell transfusion and FiO2≥40% for more than 7 days are the main influencing factors of severe BPD.The same prediction model can be used to screen out high-risk infants with severe BPD early,which provides reference for clinical early intervention to reduce the severity of BPD.