High Risk Factors Of Bronchopulmonary Dysplasia And Follow-up Analysis Of Wheezing In Infants

BackgroundWith the development of reproductive medicine,perinatal medicine,neonatal intensive care and the implementation of the comprehensive two-child policy in China.more and more extremely premature infants and super premature infants have improved survival rate,and bronchopulmonary dysplasia has become a common respiratory complication of extremely premature infants.BPD is a clinical syndrome caused by multiple factors,including the child's own factors,genetic susceptibility,maternal complications during pregnancy and various clinical events in the early postnatal period.Children are at high risk of death in infancy,and many health problems,such as long-term pulmonary diseases?mainly wheezing and infection?,growth and neurological disorders,seriously affect the quality of life after birth.More and more studies have shown that pulmonary dysplasia in premature infants will lead to a series of chronic respiratory diseases,such as bronchial asthma and chronic obstructive pulmonary diseases,which should be paid attention to.Pathophysiological changes of BPD include infection-induced lung injury and abnormal repair and reconstruction which is an important link in the occurrence of wheezing disease in infants.At present,there are relatively few reports on the characteristics of wheezing in infants?0-3 years old?with BPDObjectiveThe clinical data of children with bronchopulmonary dysplasia were analyzed to explore the risk factors of BPD;to understand the characteristics of wheezing in infants with BPD,we need analyze the follow-up indicators of wheezing in infants with BPD?0-3 years old?,the significance of tidal breathing lung function and exhaled nitric oxide?FeNO?detection.MethodsPremature infants with BPD who were hospitalized in neonatal intensive care unit of Liao Cheng Maternal and Child Health Hospital from January 2013 to December 2016 were selected as the observation group.An equal number of premature infants without BPD born in the same year were randomly selected as the control group.The study plan was approved by the medical ethics committee of Liao Cheng Maternal and Child Health Hospital and signed by the family members of the children.Medical records of children and their mothers were collected to analyze the risk factors of BPD.The patients were followed up in our hospital with questionnaires and follow-up examinations,and the incidence of bronchitis,pneumonia,wheezing attack,hospitalization due to lower respiratory diseases,drug use,family history and history of passive smoking were statistically corrected within 1 year old,2 years old and 3 years old,and tidal breathing lung function and FeNO detection were conducted.Results1.General situation:From January 2013 to December 2016,a total of 1735 premature infants,368 infants with very low birth weight and 50 children with BPD were admitted,with an overall incidence of BPD of 2.8%.The mean gestational age?27.9±1.8?weeks and mean weight?1110±233?g of premature infants in the BPD group were lower than those in the non-BPD group,the difference was statistically significant?P=0.000?.2.High risk factors for BPD:small gestational age,low body weight,cesarean section,invasive respiratory support time of>7d,oxygen concentration of>40%,patent ductus arterioside,and intrauterine infectious pneumonia were high risk factors for BPD?P<0.05?.3.Wheezing questionnaire:Children in the BPD group had bronchitis,pneumonia,and re-admission rate of lower respiratory tract disease at 0-2 years old than non-BPD group?P<0.05?,and the incidence of wheezing and inhaled glucocorticoid in the BPD group was higher than that in the non-BPD group from birth to 3 years old?P<0.05?.The rate of recurrent wheezing in BPD group was higher than that in non-bpd group?P<0.05?.The positive rate of asthma predictive index in children with BPD was not significantly different from that in the non-BPD group?P>0.05?.4.Tidal breathing lung function:respiratory frequency in BPD group<1 years old was higher than that in the control group,while tidal volume was lower than that in the control group?P<0₀5?.At the age of 0-2 years,the ratio of inspiratory time and expiratory time in the BPD group was lower than that in the control group?P<0.05?,and at the age of ?1 year,the parameter value of the ratio of inspiratory time and expiratory time in the BPD group was 0.64±0.03.lower than the normal reference range?0.67-1.0?.The parameters of TPEF/TE and VPEF/VE in the BPD group were both lower than the normal reference range,showing statistical differences with the non-bpd group?P<0.05?.5.FeNO detection:FeNO values in the BPD group and non-BPD preterm infants were in the low level of FeNO in this age group.The mean value of FeNO in the BPD group?6.3±1.3.7.2±1.4.7.5±0.9?was not significantly different from that in the non-bpd preterm group?P>0.05?.Conclusion1.The high risk factors for BPD were small gestational age,low body weight,cesarean section,invasive respiratory support time of>7d,oxygen concentration of>40%,patent ductus arterioside,and intrauterine infectious pneumonia.2.BPD children have a high rate of recurrent wheezing.The incidence of infection-induced wheezing was high before age 2 and decreased after age 2,but wheezing still occurred.3.Abnormal tidal breathing lung function in infants with BPD is mainly characterized by small airwav obstruction.4.The positive rate of asthma predictive index in children with BPD was not significantly different from that in premature infants without BPD,but the proportion of long-term inhaled glucocorticoids was significantly increased5.Exhaled nitric oxide detection hints the mechanism of wheezing and airway obstruction in BPD children is different from that of eosinophil inflammation...