支气管肺发育不良早产儿2周岁内呼吸道感染再入院分析

Premature infants with bronchopulmonary dysplasia:rehospitalization for respiratory infections within 2 years of life

目的探讨支气管肺发育不良(bronchoplumnary dysplasia,BPD)早产儿2周岁内因呼吸道感染再入院情况及危险因素。方法选择2016年1月至2017年12月温州医科大学附属第二医院收治的胎龄≤32周早产儿进行回顾性分析,根据是否发生BPD及BPD程度分为轻中度BPD组、重度BPD组和非BPD组,比较3组患儿生后2年内因呼吸道感染再入院率及再入院时的临床资料,采用Logistic回归进行再入院危险因素分析。结果共收治566例胎龄≤32周早产儿,BPD发生率为30.2%(171/566),其中轻中度BPD占81.9%(140/171),重度BPD占18.1%(31/171)。BPD早产儿2周岁内因呼吸道感染再入院率为45.0%(77/171),其中重度BPD组再入院率为71.0%(22/31),分别是非BPD组和轻中度BPD组的2.6和1.8倍。81.8%(63/77)BPD早产儿首次再入院发生在1周岁内,轻中度BPD和重度BPD组分别为83.6%(46/55)和77.3%(17/22)。重度BPD组住院次数>1次的比例较另两组显著升高(P<0.01)。对142例在本院随访的BPD早产儿进行再入院分析,发现呼吸道合胞病毒感染是再入院的主要病因,轻中度和重度BPD患儿2周岁内因呼吸道合胞病毒感染再住院率分别为6.8%(8/118)和16.7%(4/24)。轻中度和重度BPD组再住院后需呼吸支持比例高于非BPD组(P<0.05),重度BPD组入住重症监护室时间长于非BPD组和轻中度BPD组(P<0.05)。颅内出血、新生儿期住院时间长和家族性过敏体质是BPD患儿再入院的独立危险因素。结论BPD尤其重度BPD早产儿2周岁内呼吸道感染再入院率高,再入院后病情重。颅内出血、新生儿期住院时间长和家族性过敏体质是BPD患儿呼吸道感染再入院的危险因素。

Objective To study the load and risk factors of rehospitalization for respiratory infections of premature infants with bronchopulmonary dysplasia(BPD),within the first 2 years of life.Method This was a retrospective study of infants born less than 32 weeks gestational age for the year of 2016 and 2017.Based on the diagnosis and severity of BPD,the infants were classified as non-BPD,mild/moderate BPD and severe BPD group.The rate of rehospitalization for respiratory infections and clinical data during rehospitalization among the three groups were compared.Multiple logistic regression analysis were used to determine risk factors associated with respiratory infections requiring rehospitalization.Result Among the 566 premature infants,171(30.2%)had BPD and of these,140(81.9%)and 31(18.1%)were discharged with the diagnosis of mild/moderate BPD and severe BPD respectively.Within the first 2 years of life,45.0%infants with BPD had one or more rehospitalizations for respiratory infections,among them 71.0%was diagnosed with severe BPD.Compared with non-BPD group and mild/moderate group,severe BPD group had 2.6 and 1.8 times rate of rehospitalization.63 of 77(81.8%)BPD infants were rehospitalized during the first year of life,the rate of rehospitalization of mild/moderate and severe BPD infants were 83.6%(46/55)and 77.3%(17/22)respectively.The severe BPD group had higher rate of multiple rehospitalizations,which had statistically difference(P<0.01).Respiratory syncytial virus infection is the main reason for rehospitalization.Among 142 BPD infants which were followed up at our hospital,8 of 118(6.8%)mild/moderate BPD and 4 of 24(16.7%)severe BPD infants had respiratory syncytial virus related hospitalizations.The rate of respiratory support was lower in non-BPD group compared with the other two groups,and the mean length stay in intensive care unit was higher in severe BPD cases than that of the other two groups(P<0.05).In multivariable logistic analyses,intracranial hemorrhage,duration of neonatal hospitalization and family history of atopy were independently associated with rehospitalization for respiratory infections.Conclusion BPD infants have a very high risk of rehospitalization for respiratory infections in the first 2 years,especially severe BPD.And they tend to have more severe complications.Intracranial hemorrhage,duration of neonatal hospitalization and family history of atopy are the risk factors of rehospitalization for respiratory infections.