Risk factors for bronchopulmonary dysplasia in preterm infants: a systematic review and meta-analysis
Ping Xiong1, Lei Li1, Zhangbin Yu2
1Department of Neonatology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China.
Insights
This meta-analysis identified key risk factors for bronchopulmonary dysplasia (BPD) in preterm infants. Chorioamnionitis, premature rupture of membranes, and hypertensive disorders of pregnancy were significant maternal risk factors, alongside lower gestational age and male sex.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Perinatal Medicine
Background:
- Bronchopulmonary dysplasia (BPD) is the most prevalent respiratory condition in preterm infants.
- Increasing survival rates of preterm infants have led to a rise in BPD cases, posing a significant societal challenge.
- The multifactorial pathogenesis of BPD involves both genetic and environmental influences, with inconsistent findings across previous risk factor studies.
Purpose of the Study:
- To conduct a meta-analysis to identify significant risk factors associated with the development of bronchopulmonary dysplasia (BPD).
- To consolidate existing evidence on BPD risk factors to provide a clearer understanding of its etiology.
- To inform clinical practice and future research directions for BPD prevention and management.
Main Methods:
- A comprehensive literature search was performed across PubMed, Embase, Cochrane Library, and Web of Science databases.
- Case-control and cohort studies investigating risk factors for BPD were included in the meta-analysis.
- Data from 23 studies involving 14,729 BPD cases and 19,101 controls were analyzed using Review Manager and Stata.
Main Results:
- Chorioamnionitis (OR=1.52), premature rupture of membranes (OR=1.42), and hypertensive disorders of pregnancy (OR=2.73) were significant maternal risk factors.
- Lower gestational age (MD=-1.86), male sex (OR=1.41), and being small for gestational age (OR=3.14) were identified as significant infant risk factors.
- Mechanical ventilation (MD=16.55), oxygen administration (MD=50.91), blood transfusion (OR=1.38), patent ductus arteriosus (OR=1.75), sepsis (OR=1.88), and respiratory distress syndrome (OR=6.37) were also significant risk factors.
Conclusions:
- Significant risk factors for BPD include chorioamnionitis, premature rupture of membranes, hypertensive disorders of pregnancy, lower gestational age, male sex, SGA, mechanical ventilation, oxygen administration, blood transfusions, PDA, sepsis, and RDS.
- These identified risk factors have potential clinical significance for predicting BPD pathogenesis.
- The findings underscore the complex interplay of maternal and infant factors, as well as medical interventions, in the development of BPD.
Background:
Bronchopulmonary dysplasia (BPD) is the most common respiratory disease in preterm infants. As medical advancements have increased the survival rate of preterm infants, the prevalence of BPD has also increased, representing a significant societal burden. The pathogenesis of BPD is multifactorial, involving both genetic and environmental factors. Although numerous studies have examined risk factors for BPD, their findings are inconsistent. Few meta-analyses exist, yet most focus on risk factors for the development of pulmonary hypertension in infants with BPD. The primary aim of this study was to identify the risk factors for BPD.
Methods:
The study protocol was registered with PROSPERO (CRD42024616871). A comprehensive literature search was conducted in the PubMed, Embase, Cochrane Library, and Web of Science databases for case-control and cohort studies investigating risk factors for BPD. The search was completed on 22 November 2024, and the data were analyzed using Review Manager 5.3.5 and Stata 15.1.
Results:
A total of 23 studies were included in the analysis, encompassing 14,729 patients in the bronchopulmonary dysplasia (BPD) group and 19,101 in the non-bronchopulmonary dysplasia (non-BPD) group. The meta-analysis revealed that chorioamnionitis (CA) was associated with an increased risk of BPD (OR = 1.52, 95% CI [1.23-1.87]), as was premature rupture of membranes (PROM; OR = 1.42, 95% CI [1.02-1.98]). Additionally, hypertensive disorders of pregnancy (HDP) were identified as a significant risk factor for BPD (OR = 2.73, 95% CI [1.31-5.69]). Other notable risk factors included lower gestational age (GA; MD = -1.86, 95% CI [-2.35 to -1.38]), male sex (OR = 1.41, 95% CI [1.14-1.75]), and being small for gestational age (SGA; OR = 3.14, 95% CI [1.03-9.60]). Furthermore, the analysis indicated that mechanical ventilation (MV; MD = 16.55, 95% CI [9.68-23.41]), oxygen administration (MD = 50.91, 95% CI [37.40-64.42]), and blood transfusion (OR = 1.38, 95% CI [1.06-1.81]) were significant risk factors for BPD. Other variables that were identified as significant risk factors included patent ductus arteriosus (PDA; OR = 1.75, 95% CI [1.35-2.27]), sepsis (OR = 1.88, 95% CI [1.44-2.46]), and respiratory distress syndrome (RDS; OR = 6.37, 95% CI [4.00-10.13]).
Conclusions:
Significant risk factors for BPD include CA, PROM, HDP, lower GA, male sex, SGA, MV, oxygen administration, blood transfusions, PDA, sepsis, and RDS. These findings hold potential clinical significance for predicting BPD pathogenesis.
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