咖啡因与早中期早产儿发生代谢性骨病的相关性

Correlation between caffeine and metabolic bone disease in early or moderate preterm infants

目的探讨咖啡因与早中期早产儿发生代谢性骨病(MBD)的相关性。方法纳入226例胎龄≤34周的早产儿,记录其MBD的发生情况。比较MBD早产儿与非MBD早产儿的产前因素、出生情况、住院期间情况、应用咖啡因等资料,并采用Logistic回归模型分析影响早中期早产儿发生MBD的危险因素,以及咖啡因治疗持续时间累积剂量与早中期早产儿发生MBD的相关性。结果226例早中期早产儿中发生MBD 101例。MBD组和非MBD组之间胎龄、出生体重、合并宫内生长发育迟缓情况、住院时间、抗生素应用时间、应用静脉营养时间、机械通气时间、咖啡因应用剂量、咖啡因应用持续时间、咖啡因累积剂量比较,差异均有统计学意义(均P<0.05)。Logistic回归分析显示小胎龄、低出生体重、咖啡因应用持续时间长、咖啡因累积剂量大均是早中期早产儿发生MBD的独立危险因素(均P<0.05)。当咖啡因累积剂量达700 mg·d/kg或持续应用咖啡因时间达50 d时,早中期早产儿的MDB发生率均高达90%以上。结论早中期早产儿容易发生MBD,应用咖啡因的累积剂量越大、持续时间越长者MBD发生的风险越高。

Objective To explore the correlation between caffeine and metabolic bone disease(MBD)in early or moderate preterm infants.Methods Totally 226 premature infants with gestational age≤34 weeks were enrolled,and the occurrence of MBD was recorded.The premature infants with MBD and without MND were compared in terms of perinatal factors,condition at birth,hospitalization data and caffeine use,and Logistic regression model was used to analyze the risk factors for developing MBD in early or moderate preterm infants,as well as the correlation of cumulative dose of caffeine in consecutive treatment with the incidence of MBD in early or moderate preterm infants.Results Among 226 early or moderate preterm infants,MBD occurred in 101 infants.There were statistically significant differences between the MBD group and the non-MBD group in gestational age,body weight at birth,condition of concomitant intrauterine growth retardation,hospital stay,duration of antibiotics use,duration of intravenous nutrition,duration of mechanical ventilation,dose of caffeine administration,duration of consecutive caffeine administration,and cumulative dose of caffeine(all P<0.05).Logistic regression analysis revealed that younger gestational age,low body weight at birth,prolonged duration of consecutive caffeine administration,and increased cumulative dose of caffeine are the independent risk factors for developing MBD in early or moderate preterm infants(all P<0.05).The incidence rate of MBD exceeded 90%in early or moderate preterm infants when caffeine accumulated dose was 700 mg·d/kg or continuous administration of caffeine was longer than 50 days.Conclusion The early or moderate preterm infants are prone to developing MBD,and the risk of MBD is higher among preterm infants with higher accumulated dose of caffeine and longer continuous administration of caffeine.