| Objective: Through the retrospective analysis of clinical data to investigate the risk factors on incidence and severity of bronchopulmonary dysplasia(BPD) in preterm very low birth weight infants(VLBWI), to guide clinical prevention and treatment of BPD, and as far as possible to improve its prognosis.Methods: Retrospectively analyze the clinical and laboratory data of 329 preterm VLBWI admitted to the neonatal intensive care unit(NICU) more than 28 days in Suzhou Municipal Hospital from May 2012 to April 2015. Among them, 93 survived cases used oxygen therapy over 28 days were defined as BPD group, 236 cases used oxygen therapy less than 28 days were defined as non-BPD group.(1) All these preterm VLBWI were respectively grouped to three sub-groups according to birth weight(BW) and gestational age(GA) to calculate the incidence of BPD in each group: less than 1000 g, 1000-1250 g, 1251-1499g; less than 28weeks(wks), 28-32 wks, more than 32 wks.(2) The data of the premature infants’ birth conditions, maternal situation during pregnancy, neonatal admission conditions, diseases and treatment measures were compared and analyzed between BPD and non-BPD groups.(3) According to children whether to need oxygen at corrected gestational age(CGA)36 wks or discharge( if GA >=32wks, according to the aerobic conditions at postnatal 56 day), BPD group could be divided into two subgroups: 61 cases of mild BPD group(no use oxygen at CGA 36wks) and 32 cases of moderate/severe BPD group(still need oxygen at CGA 36 wks), and the clinical data of the two groups were compared.Results:Total 329 cases of VLBWI,GA range was 25+5~36 wks,average GA was(30.3±2.2)wks,BW range was 640~1480g,average BW was(1246±164)g,diagnosed BPD 93cases,the incidence of BPD was 28.3%.And the incidences of BPD subgroups with BW<1000g,1000-1250g,1251--1499g were 80%,37.1%,and 14.5%,respectively.The incidences of BPD subgroups with GA<28wks,28-32wks,>32wks were 90%,30.5%,and 2.2%,respectively.The incidence of BPD decreased significantly with increased BW and GA.Univariate regression analysis showed that the following statistics were higher in BPD group than that in non-BPD group:cesarean section,asphyxia,maternal premature rupture of membranes>18小时,maternal prenatal fever,maternal increased CRP,prenatal use of dexamethasone,pregnancy-induced hypertension,PH values of blood gas,WBC>20*109/L,hypoproteinemia,RDS,late-onset sepsis,ventilator-associated pneumonia,PDA,IVH,ROP,use of Curosurf,mechanical ventilation,more than two weeks use of CPAP,duration of Central venous catheter>30days,PN for longer than 30days,delayed enteral feeding,blood transfusion,reach half amount of enteral nutrition,the total time with oxygen and duration of hospitalization.Moreover,multivariate logistic regression analysis showed that more than two weeks use of CPAP(OR=19.544,95%CI5.946~64.247),PN for longer than 30 days(OR=7.012,95%CI 1.996~24.637),and gestational age less than 28 weeks(OR=11.344,95%CI 2.77~46.46)were independent risk factors.There were sixty-one cases mild BPD and thirty-two cases moderate/severe BPD in total ninety-three cases BPD.And statictics analysis also showed that NRDS(OR=3.746,95%CI 1.116~12.576)and NEC(OR=6.563,95%CI 1.415~30.445)were two high risk factors for influence the severity of BPD.Conclusion: The incidence of BPD was decreased significantly with increased birth weight and gestational age. The independent risk factors for BPD development were more than two weeks use of CPAP, parenteral nutrition for longer than 30 days, and gestational age less than 28 weeks. NRDS and NEC were two high risk factors for influence the severity of BPD... |
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