支气管肺发育不良早产儿不良神经发育结局的病例对照研究OA

Background Bronchopulmonary dysplasia(BPD)is a common complication in preterm infants and a significant contributor to adverse neurodevelopmental outcomes.Currently,there is limited research,both domestically and internationally,on the high-risk factors for adverse neurodevelopmental outcomes in preterm infants with BPD.Objective To investigate the risk factors for early neurodevelopmental impairment in preterm infants with BPD(gestational age≤32 weeks).Design Case-control study.Methods Preterm infants meeting the inclusion and exclusion criteria admitted to the Children's Hospital of Fudan University between January 1,2017,and December 31,2018,were enrolled.Based on the assessment results of the Peabody Developmental Motor Scales(PDMS),infants were divided into a motor development delay group and a normal motor development group.Differences between the two groups regarding general characteristics,respiratory support,laboratory findings,therapeutic interventions,comorbidities,and neurological examinations were compared to analyze the risk factors for early adverse neurodevelopmental outcomes in BPD preterm infants.Main Outcome Measures Risk factors for early adverse neurodevelopmental outcomes in BPD preterm infants.Results A total of 85 BPD preterm infants who completed the PDMS assessment by 12 months of corrected age were included,of whom 82(96.5%)underwent their first PDMS assessment at 6 months of corrected age.Among them,12 infants were in the motor development delay group and 73 in the normal motor development group.Univariate analysis revealed that the duration of invasive mechanical ventilation was longer in the delay group[7.5(2,15.7)days]compared to the normal group[3(0,9)days],with a statistically significant difference(P=0.038).The incidence of grade III or higher intraventricular hemorrhage was higher in the delay group(33.3%)than in the normal group(6.8%),with a statistically significant difference(P=0.020).The incidence of white matter injury indicated by cranial magnetic resonance imaging(MRI)was higher in the delay group compared to the normal group,with a statistically significant difference(P=0.022).Multivariate logistic regression analysis identified white matter injury indicated by cranial MRI as an independent risk factor for early motor development delay in BPD preterm infants(OR=3.549,95%CI:1.317-9.804,P=0.012).Conclusion White matter injury indicated by cranial MRI is an independent risk factor for early motor development delay in preterm infants with BPD.Enhanced follow-up and early intervention are recommended for these infants to improve prognosis.