Risk factors that affect the degree of bronchopulmonary dysplasia in very preterm infants: a 5-year retrospective
Tingting Yang1,2, Qianqian Shen2,3, Siyu Wang4
1The Affiliated Hospital of /College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China.
Insights
Severe bronchopulmonary dysplasia (BPD) in preterm infants is linked to prolonged parenteral nutrition and patent ductus arteriosus (PDA). Early PDA treatment and reduced aminophylline use may prevent severe BPD.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Bronchopulmonary dysplasia (BPD) is a common chronic lung disease in premature infants, often leading to long-term respiratory and neurodevelopmental issues.
- Severe BPD poses significant health risks, yet risk factors remain understudied.
Purpose of the Study:
- To identify risk factors associated with the severity of bronchopulmonary dysplasia (BPD) in preterm infants.
- To explore potential preventative strategies for severe BPD.
Main Methods:
- Retrospective study of 250 preterm infants (<32 weeks gestational age) diagnosed with BPD.
- Analysis of clinical data including gestational age, birth weight, and various medical interventions and complications.
- Statistical analysis to determine independent risk factors for mild, moderate, and severe BPD.
Main Results:
- Prolonged parenteral nutrition and patent ductus arteriosus (PDA) were identified as independent risk factors for severe BPD.
- Aminophylline was also a risk factor for severe BPD, while caffeine showed a protective effect in some comparisons.
- Small for gestational age (SGA) was not found to be related to BPD severity.
Conclusions:
- Shortening parenteral nutrition duration and early PDA treatment are crucial for preventing moderate to severe BPD.
- Judicious use of aminophylline and caffeine may help manage BPD severity.
- Further research is needed to clarify the role of caffeine in BPD management.
Background:
Bronchopulmonary dysplasia (BPD) is one of the most common adverse consequence of premature delivery and the most common chronic lung disease in infants. BPD is associated with long-term lung diseases and neurodevelopmental disorders that can persist into the adulthood. The adverse consequences caused by severe BPD are more serious. However, there were few studies on the risk factors for severe BPD.
Methods:
This is a retrospective study of preterm infants born less than 32-week gestational age (GA) and diagnosed with BPD.
Results:
A total of 250 preterm infants with a diagnosis of BPD and GA < 32 weeks were included (137 boys [54.8%] and 113 girls [45.2%]). The birth weight ranged from 700 g to 2010 g and the mean birth weight was 1318.52 g (255.45 g). The GA ranged from 25 weeks to 31 weeks and 6 days (mean, 30 weeks). The number of cases of mild, moderate and severe BPD were 39 (15.6%), 185 (74.0%) and 26 (10.4%), respectively. There were significant differences in the rate of small for gestational age (SGA), intrauterine asphyxia, pulmonary hemorrhage, neonatal respiratory distress syndrome (NRDS), circulatory failure, pulmonary hypertension, patent ductus arteriosus (PDA), pulmonary surfactant (PS), aminophylline, caffeine, glucocorticoids, tracheal intubation, diuretics, and parenteral nutrition length among the three groups (P < 0.05). The time of parenteral nutrition (aOR = 3.343, 95%CI: 2.198 ~ 5.085) and PDA (aOR =9.441, 95%CI: 1.186 ~ 75.128) were independent risk factors for severe BPD compared with mild BPD. PDA (aOR = 5.202, 95%CI: 1.803 ~ 15.010) and aminophylline (aOR = 6.179, 95%CI: 2.200 ~ 17.353) were independent risk factors for severe BPD, while caffeine (aOR = 0.260, 95%CI: 0.092 ~ 0.736) was the protective factor for severe BPD compared with moderate BPD. The time of parenteral nutrition (aOR = 2.972, 95%CI: 1.989 ~ 4.440) and caffeine (aOR = 4.525, 95%CI: 1.042 ~ 19.649) were independent risk factors for moderate BPD compared with mild BPD. Caffeine (aOR = 3.850, 95%CI: 1.358 ~ 10.916) was the independent risk factor for moderate BPD, while PDA (aOR = 0.192, 95%CI: 0.067 ~ 0.555) and aminophylline (aOR = 0.162, 95%CI: 0.058 ~ 0.455) were protective factors for moderate BPD compared with severe BPD. The time of parenteral nutrition (aOR = 0.337, 95%CI: 0.225 ~ 0.503) and caffeine (aOR = 0.221, 95%CI: 0.051 ~ 0.960) were protective factors for mild BPD compared with moderate BPD. The time of parenteral nutrition (aOR = 0.299, 95%CI: 0.197 ~ 0.455) and PDA (aOR = 0.106, 95%CI: 0.013 ~ 0.843) were protective factors for mild BPD compared with severe BPD.
Conclusion:
The time of parenteral nutrition is the risk factor of moderate and severe BPD. PDA and aminophylline are risk factors for severe BPD. The role of caffeine in the severity of BPD is uncertain, and SGA is not related to the severity of BPD. Severe or moderate BPD can be avoided by shortening duration of parenteral nutrition, early treatment of PDA, reducing use of aminophylline and rational use of caffeine.
Trial Registration:
Retrospectively registered.
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