早产儿早期肺动脉高压对支气管肺发育不良的预测价值

Predictive value of pulmonary arterial hypertension in the early stage in premature infants for bronchopulmonary dysplasia

目的 分析早产儿早期肺动脉高压(EPH)是否可以预测中重度支气管肺发育不良。方法 选取2021年1月至2023年6月在佛山市7家重症监护室(NICU)住院的胎龄<32周,出生后4周内诊断为EPH的64例早产儿作为观察组,按照1∶2比例随机抽取同期住院128例非EPH患儿作为对照组,收集围生期资料、临床合并症,评估早产儿EPH的危险因素和临床结局。结果 在938例符合纳入条件的早产儿中,64例(6.8%)有EPH,其中63例(98.4%)在出生2周前确诊。EPH组的胎龄、出生体重、胎膜早破>18 h、出生后需要气管插管复苏的比例明显高于非EPH组(P <0.05)。两组母亲年龄、妊娠糖尿病、妊娠高血压/子痫、产前激素使用、分娩前24 h抗生素的使用、绒毛膜羊膜炎、试管婴儿(IVF)、分娩方式、患儿性别、多胎比较,差异均无统计学意义(P> 0.05);多因素logistic回归分析显示胎龄与出生时需要气管插管复苏与早期PH有关(P <0.05);EPH组中重度支气管肺发育不良(BPD)、严重脑室内出血(IVH)、严重早产儿视网膜病变(ROP)、新生儿坏死性小肠结肠炎(NEC)、肺表面活性物质的使用比例和有创机械通气时间均明显高于对照组(P <0.05)。结论 早产儿EPH对预测中重度BPD有一定的价值。

Objective To analyze whether pulmonary arterial hypertension in the early stage(EPH)in premature infants can predict moderate to severe bronchopulmonary dysplasia.Methods A total of 64 premature infants with gestational age<32 weeks and diagnosed with EPH within 4 weeks after birth who were hospitalized in 7 neonatal intensive care unit(NICUs)in Foshan City from January 2021 to June 2023 were selected as the observation group.A total of 128 non-EPH infants who were hospitalized during the same period were randomly selected as the control group in a 1:2 ratio.Perinatal data and clinical complications were collected to evaluate the risk factors and clinical outcomes of EPH in premature infants. Results Of the 938 preterm infants eligible for inclusion, 64 (6.8%) had EPH, of which 63 (98.4%) were diagnosed before 2 weeks of birth. The proportions of gestational age, birth weight, premature rupture of membranes >18 h and tracheal intubation resuscitation after birth in EPH group were significantly higher than those in non-EPH group (P < 0.05). There were no significant differences in m aternal age, gestational diabetes mellitus, gestational hypertension/eclampsia, prenatal hormone use, prenatal 24 h antibiotic use, chorioamniotitis, in vitro preterm birth (IVF), delivery mode, child sex and multiple births between the two groups (P > 0.05). There were no significant differences between the two groups in maternal age, diabetic hypertension, prenatal hormone use, prenatal antibiotic use, chorioamnionitis, IVF, delivery mode, child sex, multiple births. (P > 0.05). Multivariate logistic regression analysis showed that gestational age was associated with the need for tracheal intubation resuscitation at birth and PH in the early stage (P < 0.05). The proportion of severe bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH), severe retinopathy of prematurity (ROP), neonatal necrotizing enterocolitis (NEC), the proportion of pulmonary surfactant use, and invasive mechanical ventilation time in the EPH group were significantly higher than those in the control group (P < 0.05). Conclusion EPH in premature infants is valuable in predicting moderate to severe BPD.