| Objective:To investigate retrospectively the occurrence of bronchopulmonary dysplasia(BPD)in premature infants with SGA and non-SGA,so as to guide clinical prevention and treatment of BPD and improve its prognosis as far as possible.Methods:A retrospective analysis was conducted on 549 premature infants who were transferred to the neonatal intensive care unit(NICU)of Children's Hospital Affiliated to Soochow University from November 2015 to November 2017 and were hospitalized for at least 28 days.According to diagnosis,these children were divided into SGA group and non-SGA group,and they were further divided into BPD-SGA and non BPD-SGA groups based on BPD rate.By the analysis and comparison of SGA and non-SGA group,this paper tries to figure out the incidence rate and risk factors of BDP in SGA group and non-SGA group,and to study the basic data of these infants,the information during pregnancy,common diseases and relative treatments.Results:1.The incidence rate of BDP in SGA and non-SGA groups:549 premature infants are the subjects.SGA group consists of 181 infants,26 of whom are with BPD,rating 14.36%,while non SGA group consists of 368 infants with 134 BDP,rating 36.41%.After adjusting for gestational age and birth weight,the incidence rate of BDP in SGA is much lower than that of non-SGA group(P<0.05).2.The general information,maternal pregnancy,basic diseases and treatment of BPD-SGA group and BPD-non-SGA group were compared.It showed that the gestational age,mother's age and the incidence rate of pre-eclampsia were all significantly higher than those in the BPD-non-SGA group(P<0.05).However,the birth weight,incidence of congenital heart disease,apnea and utilization rate of PS treatment,invasive mechanical ventilation duration were significantly lower than those in the BPD-non-SGA group.(P<0.05).3.Risk factors of BDP in SGA and non-SGA3.1 Risk factors of BDP in SGA groupGestational age,CPAP duration and invasive mechanical ventilation duration are independent risk factors for BPD in SGA group.The risk of BPD was 0.483 times higher for every unit of gestational age(protective factor).For every unit of CPAP increased,the risk increased by a factor of 1.254 times(risk factors).For every unit of invasive mechanical ventilation duration increased,the risk increased by a factor of 1.260 times(risk factors).On this basis,ROC curve was drawn,area under the curve was calculated,and Logistic regression model was constructed to predict the incidence rate of BDP in SGA.The results showed that the area under the curve of gestational age and CPAP was 0.822(95%CI:0.729-0.915)?0.928(95%CI:0.872-0.983)and 0.663(95%CI:0.538-0.787),respectively.Using the predictive variable as the test variable,the results showed that the area under the ROC curve of the above three indexes combined Logistic regression model was 0.954,the sensitivity was 92.3%,and the specificity was 85.8%,higher than the three indexes predicted separately.3.2 Risk factors of BDP in non-SGA groupGestational age,NRDS,CPAP duration,invasive mechanical ventilation duration and aminophylline utilization rate were independent risk factors for BPD in non-SGA group.For every unit of gestational age,the risk of BPD was reduced by 0.597.The risk of BPD in individuals with NRDS is 2.008 times that of individuals without NRDS.For every unit of CPAP increased,the risk increased by a factor of 1.208 times.For every unit of invasive mechanical ventilation duration increased,the risk increased by a factor of 1.185 times(risk factors)..Aminophylline users were 2.170 times more at risk than non-users.On this basis,ROC curve was drawn,area under the curve was calculated,and Logistic regression model was constructed to predict the incidence rate of BDP in non-SGA group.The results showed that the area under the curve of gestational age,NRDS,CPAP duration,invasive mechanical ventilation duration and aminophylline utilization rate were 0.828(95%CI:0.782-0.873)?0.670(95%CI:0.611-0.729)?0.873(95%CI:0.834-0.913)?0.616(95%CI:0.554-0.678)and 0.651(95%CI:0.592-0.710),respectively.Using the predictive variable as the test variable,the results showed that the area under the ROC curve of the above 5 indexes combined Logistic regression model was 0.925,the sensitivity was 82.80%,and the specificity was 87.60%,all higher than the 5 indexes predicted separately.Conclusion:1.After adjusting for gestational age and birth weight,the incidence rate of BPD in SGA group was lower than that in non-SGA group;2.The basic situation comparison between the BPD-SGA group and the BPD-non-SGA group showed that the incidence of pre-eclampsia in the BPD-SGA group was significantly higher than that in the BPD-non-SGA group.However,the birth weight,incidence of congenital heart disease,apnea and utilization rate of PS treatment invasive,mechanical ventilation duration were significantly lower than those in the BPD-non-SGA group.3.Gestational age,CPAP time and mechanical ventilation duration are independent risk factors for BPD-SGA;Gestational age,NRDS,CPAP time,mechanical ventilation duration and use of aminophylline are independent risk factors for preterm delivery of non-SGA BPD. |
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