Longer duration of initial invasive mechanical ventilation is still a crucial risk factor for moderate‑to‑severe bronchopulmonary dysplasia in very preterm infants:a multicentrer prospective study

Objectives We aimed to evaluate the risk factors for moderate-to-severe bronchopulmonary dysplasia(BPD)and focus on discussing its relationship with the duration of initial invasive mechanical ventilation(IMV)in very preterm neonates less than 32 weeks of gestational age(GA).Methods We performed a prospective cohort study involving infants born at 23–31 weeks of GA who were admitted to 47 different neonatal intensive care unit(NICU)hospitals in China from January 2018 to December 2021.Patient data were obtained from the Sina-northern Neonatal Network(SNN)Database.Results We identified 6538 very preterm infants,of whom 49.5%(3236/6538)received initial IMV support,and 12.6%(823/6538)were diagnosed with moderate-to-severe BPD symptoms.The median duration of initial IMV in the moderateto-severe BPD group was 26(17–41)days,while in the no or mild BPD group,it was 6(3–10)days.The incidence rate of moderate-to-severe BPD and the median duration of initial IMV were quite different across different GAs.Multivariable logistic regression analysis showed that the onset of moderate-to-severe BPD was significantly associated with the duration of initial IMV[adjusted odds ratio(AOR):1.97;95%confidence interval(CI):1.10–2.67],late-onset neonatal sepsis(LONS),and patent ductus arteriosus(PDA).Conclusion In this multicenter cohort study,the duration of initial IMV was still relatively long in very premature infants,and the longer duration of initial IMV accounts for the increased risk of moderate-to-severe BPD.

Treatment status of extremely premature infants with gestational age<28 weeks in a Chinese perinatal center from 2010 to 2019

Background There is a paucity of studies conducted in China on the outcomes of all live-birth extremely premature infants(EPIs)and there is no unifed recommendation on the active treatment of the minimum gestational age in the feld of perinatal medicine in China.We aimed to investigate the current treatment situation of EPIs and to provide evidence for formulating reasonable treatment recommendations.Methods We established a real-world ambispective cohort study of all live births in delivery rooms with gestational age(GA)between 24+0 and 27+6 weeks from 2010 to 2019.Results Of the 1163 EPIs included in our study,241(20.7%)survived,while 849(73.0%)died in the delivery room and 73(6.3%)died in the neonatal intensive care unit.Among all included EPIs,862(74.1%)died from withholding or withdrawal of care.Regardless of stratifcation according to GA or birth weight,the proportion of total mortality attributable to withdrawal of care is high.For infants with the GA of 24 weeks,active treatment did not extend their survival time(P=0.224).The survival time without severe morbidity of the active treatment was signifcantly longer than that of withdrawing care for infants older than 25 weeks(P<0.001).Over time,the survival rate improved,and the withdrawal of care caused by socioeconomic factors and primary nonintervention were reduced signifcantly(P<0.001).Conclusions The mortality rate of EPIs is still high.Withdrawal of care is common for EPIs with smaller GA,especially in the delivery room.It is necessary to use a multi-center,large sample of real-world data to fnd the survival limit of active treatment based on our treatment capabilities.