胎盘病理与极早产儿中重度支气管肺发育不良的相关性OA

Objective To investigate the risk factors for moderate-severe bronchopulmonary dysplasia(msBPD)in extremely preterm infants,and to evaluate the correlation between placental pathology and msBPD.Methods The clinical data of 214 extremely preterm infants(gestational age<32 weeks)admitted to the Neonatal Intensive Care Unit,the First People's Hospital of Foshan from January 2019 to December 2023 were retrospectively collected.According to the BPD grading,they were divided into the control group(no/gradeⅠBPD,n=176)and the msBPD group(grade Ⅱ/Ⅲ/ⅢA BPD,n=38).The differences in risk factors between the msBPD group and the control group were compared.Multivariate Logistic regression analysis was used to screen the risk factors for msBPD in extremely preterm infants,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of clinical indicators for msBPD.The statistical analysis was performed using independent samples t-test,non-parametric test and χ2 test.Results The gestational age and birth weight of infants in the msBPD group were significantly lower than those in the control group(all P<0.001).The proportions of intraventricular hemorrhage(IVH),hemodynamically significant patent ductus arteriosus(hsPDA),small for gestational age(SGA),1 min Apgar score≤7 points,invasive ventilation time>7 days,and intubation in the delivery room were significantly higher than those in the control group(all P<0.05),while the rate of prenatal corticosteroid use was significantly lower(P=0.006).Placental pathology analysis further revealed that the proportion of acute histologic chorioamnionitis with fetal inflammatory response(HCA FIR+)in the msBPD group was significantly higher than that in the control group[34.21%(13/38)vs 8.52%(15/176),P<0.001].The results of multivariate Logistic regression analysis showed that perinatal IVH(95%CI:2.162-16.667,P=0.001),invasive ventilation time>7 days(95%CI:1.959-20.882,P=0.002),and HCA FIR+(95%CI:1.448-5.581,P=0.002)were the independent risk factors for msBPD.The results of ROC curve analysis showed that the combination of these three factors for diagnosing msBPD yielded an area under the curve of 0.869(95%CI:0.803-0.936).Conclusion The main risk factors for msBPD in extremely preterm infants are perinatal IVH,invasive ventilation time>7 days,and HCA FIR+.In clinical practice,comprehensive assessment is necessary for early detection,diagnosis,and treatment to reduce the incidence of msBPD and improve its prognosis.