胎龄<32周早产儿中重度支气管肺发育不良危险因素的多中心回顾性分析

目的 分析胎龄<32周早产儿中重度支气管肺发育不良（bronchopulmonary dysplasia，BPD）的危险因素。 方法 回顾性收集2019年1月1日至2020年12月31日江苏省新生儿围产期协作网17家单位新生儿重症监护室收治的胎龄<32周且住院时间≥28 d诊断为BPD早产儿的临床资料，依据胎龄和BPD严重程度分组，采用多因素logistic回归分析不同胎龄段发生中重度BPD的危险因素。 结果 2年间17家协作单位新生儿重症监护室收治的胎龄<32周早产儿共2 603例，诊断BPD的961例，BPD发生率为36.92%（961/2 603），中重度发生率为8.64%（225/2 603），24⁺⁰~25⁺⁶周早产儿中重度BPD发生率为56.5%（26/46），26⁺⁰~27⁺⁶周早产儿中重度BPD发生率为31.0%（66/213），28⁺⁰~29⁺⁶周早产儿中重度BPD发生率为16.9%（75/445），30⁺⁰~31⁺⁶周早产儿中重度BPD发生率为22.6%（58/257）。多因素logistic回归分析显示，各胎龄段早产儿中重度BPD危险因素不尽相同：24⁺⁰~25⁺⁶周为需治疗的动脉导管未闭；26⁺⁰~27⁺⁶周为胎膜早破≥18 h、复苏正压通气、临床败血症、机械通气时间≥14 d；28⁺⁰~29⁺⁶周为机械通气时间≥14 d、新生儿肺炎、需治疗的动脉导管未闭；30⁺⁰~31⁺⁶周为复苏正压通气、新生儿肺炎、早产儿贫血（均P<0.05）。 结论 胎龄<32周早产儿中重度BPD是多种因素共同作用的结果，并且每个胎龄段存在不尽相同的高危因素，对不同胎龄段提前采取有针对性举措，将有助于减轻BPD严重程度。

Risk factors for moderate/severe bronchopulmonary dysplasia in preterm infants with a gestational age of <32 weeks: a multicenter retrospective analysis

Objective To investigate the risk factors for moderate/severe bronchopulmonary dysplasia (BPD) in preterm infants with a gestational age of <32 weeks. Methods A retrospective analysis was performed on the medical data of preterm infants with a gestational age of <32 weeks and a length of hospital stay of ≥28 days who were admitted to the neonatal intensive care unit (NICU) of 17 institutions of Jiangsu Neonatal Perinatal Cooperation Network from January 1, 2019 to December 31, 2020 and were diagnosed with BPD. The preterm infants were grouped according to gestational age and severity of BPD. A multivariate logistic regression analysis was used to investigate the risk factors for moderate/severe BPD in various gestational age groups. Results During the two-year period, a total of 2 603 preterm infants with a gestational age of <32 weeks were admitted to the NICU of the 17 institutions, among whom 961 were diagnosed with BPD, and the incidence rates of BPD and moderate/severe BPD were 36.92% (961/2 603) and 8.64% (225/2 603), respectively. The incidence rate of moderate/severe BPD was 56.5% (26/46) in preterm infants with a gestational age of 24+0-25+6 weeks, 31.0% (66/213) in those with a gestational age of 26+0-27+6 weeks, 16.9% (75/445) in those with a gestational age of 28+0-29+6 weeks, and 22.6% (58/257) in those with a gestational age of 30+0-31+6 weeks. The multivariate logistic regression analysis showed that there were different risk factors for moderate/severe BPD in preterm infants with different gestational ages: patent ductus arteriosus requiring treatment as risk factors in preterm infants with a gestational age of 24+0-25+6 weeks; premature rupture of membranes ≥18 hours, positive pressure ventilation for resuscitation, clinical sepsis, and duration of mechanical ventilation ≥14 days as risk factors in preterm infants with a gestational age of 26+0-27+6 weeks; duration of mechanical ventilation ≥14 days, neonatal pneumonia, and patent ductus arteriosus requiring treatment as risk factors in preterm infants with a gestational age of 28+0-29+6 weeks; positive pressure ventilation for resuscitation, neonatal pneumonia, and anemia of prematurity as risk factors in preterm infants with a gestational age of 30+0-31+6 weeks (P<0.05). Conclusions The development of moderate/severe BPD is multifactorial in preterm infants with a gestational age of <32 weeks, and there are different risk factors in different gestational age groups. Targeted preventive measures for preterm infants of different gestational ages may be useful to reduce the severity of BPD.