| Objective To study the risk factor that influence in early onset pulmonary hypertension developed into bronchopulmonary dysplasia in Gestational Age < 32 weeks premature infants.MethodRetrospectively analyzed the early onset pulmonary hypertension patients from 2013 to 2015 in Chongqing medical university affiliated children’s hospital neonatal ward, and whose gestational age(GA) was<32w, hospitalized days was <7 days, and died within 28 days was eliminated. It is divided into two groups with the BPD and without the BPD. The related factors that include the general situation and situation of the mother during pregnancy, color doppler echocardiography,complications, treatment were analyzed.Using( ±S)to present if the measurement data conform the normal distribution. Using analysis of variance between groups. Using the t test if the variance is coincident, if not, using nonparametric test; Using the median(interquartile) to present counting data. Using chi-square test to compare the differences between the two groups, P<0.05 if the differencewas statistically significant. According to the results of single factor analysis, choose meaningful variables into Logistic regression analysis, and screen out risk factor for BPD. The P value that less than 0.05 is the significant boundaries, and logistic regression equation is established.ResultThe Neonatal center of Children’s Hospital of Chongqing Medical University, rang form 2013.1 to 2015.12, treated 182 cases with early PH,who’s GA<32w, excluding 86 cases who were dead or give up in hospitalization<28d and incomplete information. The study included 96 cases. the 65 cases(67.7%) with BPD, 31 cases(32.3%) without BPD.1. In general, The average GA was(30.3±1.2)w, the min of GA was27+2w. GA<30w: 36 cases, 29 cases(80.6%) in BPD group. The difference of the GA was statistically significant between two groups(χ2=4.384,P=0.037). Suggested that the smaller of GA, the higher of incidence of BPD.The average birth weight was(1473.1±292.3)g,the min was 770 g. There were 56 cases who’s birth weight<1500g, 44 cases in BPD group. The difference of the birth weight was statistically significant between two groups(χ2=7.254;P=0.003).Suggested that the smaller of birth weight, the higher of incidence of BPD.In the study,there were 55 boys: 42 boys in BPD group, χ2=4.412,P=0.036,The difference of the sex was statistically significant between two groups,and the boys have higher incidence of BPD.The difference of the Sex, Gestational age and birthweight was statistically significant between two groups(P<0.05);There was no statistically significant difference between two groups of the less than gestational age, multiple pregnancies, intrauterine distress, premature rupture of membranes and Apgar 1 minutes score.(P>0.05).2. The situation during pregnancy: mother mean age(30.5±5.6) years old, 21 cases in less than 20 or more than 35 years old;.44 cases of cesarean section;13 cases of gestational diabetes; 14 cases of gestational hypertension; Prenatal use of glucocorticoid in 31 cases. All of them were no statistically significant difference between two groups(P>0.05).3. Color doppler echocardiography(CDE):All of them was did the CDE in 14 d age. PDA were 91 cases(94.8%). Interatrial septum tumor expansion were 17 cases;74 cases of atrial septal defects;Patent foramenovale in 24 cases;27 cases of moderately severe tricuspid regurgitation,All of them were no statistically significant difference between two groups(P>0.05).In PDA there were 46 cases(50.5%)of PDA that diameter was less than 3 mm,His incidence of BPD was higher(78.3%vs 58.0%).but there was also no statistically significant difference between two groups(χ2=3.561,P=0.059).4. The complications. 70 cases of NRDS,.84 cases of intracranial hemorrhage, Pulmonary hemorrhage in 22 cases, 12 cases of NEC, 44 cases of sepsis. All of them were no statistically significant difference between two groups(P>0.05).5. Treatment: In the study,use of lung surface active substances in 80cases(83.3%), 60 cases in BPD group(75.0),the difference was statistically significant between two groups(P<0.05). The use of vasoactive drugs in50 cases, of which 40 cases(80%) in BPD group, P=0.007, the difference was statistically significant. Respirator treatment,and total oxygen time,the difference was statistically significant between two groups(P<0.05). The BPD group was more.Sildenafil or inhaled NO treatment in 11 cases, there was no statistically significant difference between two groups(P>0.05).6. Multiariable logistic regression analysis:birth weight, repirator treatment time, gender, diameter of PDA that more than 3mm are independent risk factors for PH with BPD.Conclusion1 Gender(male), birth weight less than 1500 g and gestational age less than 30 weeks, repirator treatment time is risk factors for early onset PH developed into BPD.2 Gender, birth weight, repirator treatment time, diameter of PDA that more than 3mm are independent risk factors for early onset PH developed into BPD. Avoid extremely low weight preterm birth, shorten the respirator treatment time is an important measure to prevent PH developed into BPD. |
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