Risk Factors And Early Prediction Of Bronchopulmonary Dysplasia Of Very Premature Infant

Objective To explore the clinical risk factors of bronchopulmonary dysplasia(BPD)in very premature infants,and to detect serum interleukin 33(IL-33),tumor necrosis factor alpha(TNF-?)and neutrophil gelatinase in different time periods The level of neutrophil gelatinase-associated lipocalin(NGAL)was analyzed to predict its early predictive effect on bronchopulmonary dysplasia,reduce the incidence of BPD in premature infants,reduce the mortality of premature infants and improve the long-term outcome of children with BPD The prognosis of the period has clinical guiding significance.Method Designed the "NICU Very Premature Infants Survey Registration Form" to collect 66 cases of very premature infants(referring to premature infants with gestational age of 28 to 32 weeks)from the Department of Maternal and Child Health Hospital of Anhui Medical University from March 1,2018 to September 30,2019)Clinical data,divided into BPD group(n = 25)and non-BPD group(n = 41)according to the diagnostic criteria of BPD:(1)statistically compare the clinical data of the two groups and analyze the clinical risk of BPD in very premature infants Factors;(2)Enzyme-linked immunosorbent assay(ELISA)method was used to detect IL-33,TNF-?and NGAL in the serum of the included standard preterm infants on days 1,14 and 28 after birth Content;use software SPSS 23.0 to make statistics on the data,analyze whether there are differences between the two groups of different time periods and different levels of BPD,and make receiver operating characteristic curve(ROC),according to the curve The area(area under the curve,AUC)yields the early predictive effectiveness of various indicators.Result A total of 66 very premature infants were included,33 males(50%)and 33females(50%);5 patients with body weight ?1000g,55 patients with 1000-1500 g,and5 patients with 1500-2000g;25 patients in the BPD group with an incidence rate of37.9 %,Of which 15 cases were mild,8 cases were moderate,and 2 cases were severe.The clinical risk factors for BPD in very premature infants are: gestational age,birth weight,length of hospitalization,premature rupture of membranes,maternal chorioamnionitis,neonatal respiratory distress syndrome(NRDS),mechanical ventilation,brain Injuries,pulmonary hypertension(PH),retinopathy(ROP),patent ductus arteriosus(PDA),etc.Independent risk factors for BPD in very premature infants: premature rupture of membranes(OR=0.179,95% CI: 0.049~0.648),premature infants with PDA(OR=0.205,95% CI: 0.056~0.0.745),yes The mechanical ventilation time was ?7 days(OR = 0.070,95% CI: 0.006~0.806).Early prediction of BPD in premature infants:(1)The serum NGAL level of children in the BPD group was significantly higher than that in the non-BPD group on the 1st and14 th days,and reached a peak on the 14 th day,and then gradually decreased,the difference was statistically significant(P<0.05),but there was no significant difference in serum NGAL levels in non-BPD groups at different time periods(P>0.05);NGAL expression levels in children with mild,moderate and severe BPD were not significantly different on day 1,day 14 and day 28(P>0.05);(2)The serum IL-33 level of children in the BPD group was significantly higher than that in the non-BPD group on day 1,day14,and day 28,and the day 14 was significantly higher than day 1,the difference Significantly significant(P<0.05);IL-33 expression level in non-BPD group at different time periods was not significantly different(P>0.05);serum IL-33 level was significant on the 14 th and 28 th day of severe BPD group There was a statistically significant difference between children with mild and moderate BPD(P <0.05),and there was no significant difference in the expression level of serum IL-33 on day 1 of different degrees of BPD(P> 0.05);(3)Children in BPD group The level of serum TNF-? was significantly higher than that of the non-BPD group on day 1,day 14,and day 28,the highest on day 14,and then gradually decreased,the difference was statistically significant(P<0.05);the expression level of TNF-? in the non-BPD group at different time periods was not significantly different(P>0.05);serum TNF-? was not significant on children with mild,moderate and severe BPD on day 1,day 14 and day 28Difference(P>0.05);(4)ROC curve analysis showed premature rupture of membranes,PDA,mechanical ventilation time ? 7 days,NGAL(day 1),IL-33(day 1),TNF-?(day1 Days),NGAL(day 14),IL-33(day 14),TNF-?(day 14)early prediction of the area under the curve(AUC)value of BPD was 0.473,0.642 0.588,0.768,0.752,0.760,0.875,0.978,0.975.Conclusion 1)The incidence of BPD is very high in very premature infants,with small gestational age,low body weight,long time of oxygen inhalation,mechanical ventilation,and PDA being the main risk factors.(2)IL-33,NGAL and TNF-? can predict the occurrence of BPD early,and the NGAL level has the highest predictive efficacy on the first day after birth,IL-33 has the highest predictive efficacy on the 14 th day,and IL-33 may also be As an indicator to assess the severity of BPD,clinically actively reduce the risk factors of BPD,predict the occurrence of BPD early,and timely intervention can reduce its morbidity,reduce mortality,and improve the prognosis of premature infants.