| Premature children,low birth weight infants,especially very low birth weight and extremely low birth weight infants become more and more,the application of prenatal glucocorticoid and postnatal pulmonary surfactant and the improvement of protective ventilation have significantly improved the prognosis of preterm infants,the survival rate was greatly improved,but the incidence of bronchopulmonary dysplasia(BPD)did not decrease significantly.For the children with BPD mostly are small gestational age premature children,have low birth weight,history of mechanical ventilation,hospitalization for a long time,often appear alveolar,pulmonary microvascular dysplasia and pulmonary fibrosis changes,easy to leave repeated respiratory tract infection,growth retardation,feeding difficulties and airway hyperresponsiveness,and so on.Tidal breathing lung function testing in recent years is a new technology for infants and young children,the method is a non-invasive examination,and it's simple and reproducible.For family members,they are easy to accept and for children,it do not needs special coordination.This testing focuses more on physiology state of lung function changes,it can be sensitive to respond to children with tidal breathing respiratory function status of children with BPD.Currently its clinical applications become more and more,also it can help us understand the neonatal lung development and lung maturity,and provide the basis for the clinical diagnosis and treatments.ObjectiveTo investigate the incidence of bronchopulmonary dysplasia(BPD)in different gestational age preterm infants,the risk factors and their pulmonary function by collecting their clinical data who were born and accepted treatments in our hospital.Materials and methods1.Determine the research objectFrom January 1,2013 to December 31,2016,preterm infants with BPD were admitted and treated in the Third Affiliated Hospital of Zhengzhou University.The subjects were selected for inclusion criteria:(1)Premature infants born in the hospital,transferred to the neonatal intensive care unit after the evaluation of vital signs immediately;(2)Gestational age<37 weeks,ignoring their gender;(3)Consistent with the new BPD diagnostic criteria adopted by the National Institute of Child Health and Human Development(NICHD)2000;(4)Survival time>28 days;(5)Excluding serious congenital diseases(such as severe congenital heart disease),diaphragmatic hernia,congenital malformations(such as thoracic deformity,throat malformation)which may affect the lung function and those whose information is not integrated,lost to follow-up and having adverse outcomes.According to the gestational age,preterm infants with BPD were divided into four groups:(1)gestational age less than 28 weeks;(2)gestational age more than 28weeks less than 32 weeks;(3)gestational age more than 32 weeks less than 34 weeks;(4)gestational age more than 34 weeks less than 37 weeks.The children with BPD were divided into 2 groups according to whether they performed tidal breathing pulmonary function tests or not:group A was used for the tidal breathing pulmonary function test group,and group B was not subjected to the tidal breathing pulmonary function test group.According to the gestational age,elected preterm infants with BPD were assessed into different ranks of the severity at different times after birth,and among them,we had 52 patients with mild BPD,18 patients with moderate BPD,and 13patients with severe BPD,then we analyzed their tidal breathing lung function.2.1 Clinical data collectionCollecting the information on the admission and treatment of premature babies during the study period.Data comparisons and analysis were conducted on children with BPD that met the inclusion criteria,such as gestational age,birth weight,length of hospital stay,oxygen inhalation time,nasal continuous positive airway pressure(NCPAP)time,invasive mechanical ventilation time,mechanical ventilation time(total invasive ventilation time and NCPAP time).2.2 Assessment the severity in preterm infants with BPDThe severity of BPD was evaluated at different time after birth.If the gestational age is<32 weeks,the evaluation is performed at 36 weeks or when the child is discharged.If the gestational age is>32 weeks,the evaluation is performed after56days or when the child is discharged.(1)Minor:no oxygen;(2)Moderate:inhalation of oxygen concentration(FiO2)<30%;(3)Severity:FiO2:30%or mechanical ventilation required.2.3 Tidal breathing lung function testThe inspection of moisture and respiratory lung function to the children with BPD were examined when they are in 40 to 44 weeks.No respiratory symptoms and signs were detected during the test,Oxygen saturation was maintained at about 90%in the absence of oxygen,their vital signs are stable.The lung function instrument produced by the professionals in our hospital lung function room using the machine operated by JAEGER company of Germany.Measurable parameters are TPEF(Time to reach peak tidal expiratory flow),TPEF/TE(Ratio of the time to reach peak tidal expiratory flow to total expiratory time),VPEF(Volume to reach peak tidal expiratory flow),VPEF/VE(Ratio of the volume to reach peak tidal expiratory flow to total expiratory time),TI(Inspiratory time),TE(Expiratory time),VT/kg(Tidal volume/kg),TI/TE(Ratio of inspiratory time to expiratory time),RR(Respiratory Rate),TEF75%(TEF75%remaining),TEF50%(TEF50%remaining);and their weight and length when measured.Results3.1 BPD occurrenceA total of 43426 newborn babies were born on the January 01,2013 until the December 31,2016.The number of premature infants was 8,538.There were 355cases of premature infants with BPD,and the total incidence of BPD was 4.16%.Among them,there were 115 cases of premature infants under 28 weeks of gestational age(33.91%).271 cases of the 3063 cases in 28~32 weeks(8.85%),35cases Of the 2144 cases in 32~34 weeks(1.63%),10 cases of the 3216 cases in34~37 weeks(0.31%).The incidence of BPD increased gradually with the age of birth.The difference was statistically significant(?~2=578.29,P<0.001).3.2 Clinical analysis of different degrees of BPD.Among 355 children with BPD,there were 243 are in mild group,51 in moderate group and 61 in severe BPD group.The differences were significant in gestational age,birth weight,hospitalization time,oxygen time and mechanical ventilation time in children with Varying degrees of BPD(P<0.05).The less the gestational age,the lower the birth weight,the longer the oxygen time,especially the longer the ventilation mechanical time,the greater the degree of BPD.In addition,the proportion of premature infants with gestational age<32 weeks,the birth weight<1500g was significantly increased with the increase of BPD degree,and the difference was statistically significant(P<0.05).3.3 Analysis of respiratory and pulmonary function in children with BPD.Comparing and analyzing the clinical information of the baby who was performed on the respiratory function and the data of the children who did not checked.There was no significant difference in gestational age,weight,oxygen absorption time,mechanical ventilation time,etc,it shows that there was no significant bias in the determination of pulmonary function.In preterm infants who have tidal respiratory function tests,there were statistically significant differences in peak time ratio,peak volume and peak volume ratio,P<0.05.And there was no statistically significant difference at the peak time,the peak volume,the suction ratio,the exhalation time,the inhalation time,the tidal volume of the kilogram,the respiration rate,the 75%TEF,the 50%TEF,and so on(P>0.05).Conclusions1.Different occurrence rates of bronchopulmonary dysplasia in preterm infants with different gestational ages,the smaller the gestational age,the higher the incidence.2.The children with bronchopulmonary dysplasia have different degrees of tidal breathing lung function injury,and the more severe the degree,the more obvious the limitation of moisture respiratory lung function was. |
PDF Full Text Request