| Objective:To explore the influencing factors of bronchopulmonary dysplasia（BPD）in preterm infants and construct an early risk prediction model（on postnatal days 14）to provide evidence for early identification and screening of high-risk infants with BPD.Methods:A retrospective analysis was performed on the medical data of preterm infants who were admitted to the Neonatal Intensive Care Unit of Zhongda Hospital Affiliated to Southeast University from January 2017 to June 2021.The infants were classified into the BPD and non-BPD groups based on diagnostic criteria of National Institute of Child Health and Human Development for BPD revised in 2018.Univariate analysis was used to compare the general status,laboratory examination results,treatments,and complications and the clinical factors affecting BPD between two groups.Combined with clinical practice,the variables with P<0.2 in univariate analysis were screened by Lasso regression.Thereafter,logistic regression was applied to explore the effective variables and establish an early risk prediction model for BPD with a visual nomogram,and the differentiation degree and calibration degree of the model were evaluated.Results:1.A total of 333 infants were included in this study.According to the 2018 criteria,69cases（20.72%）were diagnosed with BPD.The incidence of BPD in preterm infants with gestational age<28 w was 52.94%（18/34）,which was significantly higher than those with30～32 w and 28～29+6w（all P<0.01）.The incidence of BPD in preterm infants with birth weight<1000 g was 73.53%（25/34）,which was significantly higher than those with birth weight>1500 g and 1000～1500 g（all P<0.01）.2.Univariate analysis showed that there were significant differences in the gestational age,birth weight,1 min and 5 min Apgar score,maternal prenatal infection,platelet,albumin,serum creatinine,blood urea nitrogen,times of human immunoglobulin infusion,times of albumin transfusion,erythrocyte transfusion,glucocorticoid,aminophylline/caffeine,long-term diuretics,pulmonary surfactant（PS）,L-carnitine,severe asphyxia,pulmonary hemorrhage,neonatal necrotizing enterocolitis,retinopathy of prematurity,sepsis,pulmonary hypertension,haemodynamiclly significant patent ductus arteriosus,endotracheal intubation,secondary intubation,conventional mechanical ventilation,high frequency oscillatory ventilation,nasal intermittent positive pressure ventilation,invasive ventilation time,noninvasive ventilation time,oxygen inhalation time,total oxygen absorption time,normal frequency mechanical ventilation time,nasal continuous positive airway pressure time,mechanical ventilation≥7 d,fraction of inspired oxygen(Fi O2)≥40%more than 7 d,parenteral nutrition time,parenteral nutrition≥7 d,enteral feeding initiated time,beginning of enteral nutrition within 3 d after birth,intake on the 1st～2ndd after birth,oral intake on the2nd～7thd after birth,output on the 2nd～7thd after birth,and fat milk on the 4th～7thd after birth between the two groups（all P<0.05）.3.Logistic regression analysis showed that 1 min Apgar score（β=-0.180,OR=0.835）,times of erythrocyte transfusion（β=0.314,OR=1.370）,usage of PS（β=1.899,OR=6.681）,application of diuretics long time（β=0.812,OR=2.253）and Fi O2≥40%more than 7 d（β=2.802,OR=16.478）were independent risk factors for BPD.4.The model with a C-index of 0.890（95%CI:0.847～0.932）and a calibrated C-index of 0.889（95%CI:0.849～0.932）was more than 0.75.The calibration curve shown that the Apparent line had a high degree of coincidence with the Bias-corrected line and the Ideal line.Conclusions:1.The prevalence of BPD is high in very preterm infants,especially those with younger gestational age and lower birth weight have a higher prevalence rate.2.BPD is the result of a combination of factors,therefore avoiding premature birth,shortening ventilation time,reducing high-concentration oxygen inhalation time,strictly controlling blood transfusion indications,maintaining fluid balance,and ensuring adequate calorie can help to decrease the occurrence of BPD and improve the quality of life of preterm infants.3.1 min Apgar score,times of erythrocyte transfusion,usage of PS,application of diuretics long time and Fi O2≥40%more than 7 d were independent risk factors for BPD.The early risk prediction model with a differentiation degree and calibration degree can predict the occurrence of BPD early,screen out the high-risk infants with a potential BPD,and provide a basis for further individualized prevention and treatment. |
