Antenatal Determinants of Bronchopulmonary Dysplasia and Late Respiratory Disease in Preterm Infants
Antenatal Determinants of Bronchopulmonary Dysplasia and Late Respiratory Disease in Preterm Infants
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早产儿支气管肺发育不良和晚期呼吸系统疾病的产前决定因素
DOI：
10.1164/rccm.201612-2414oc
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发表时间：
2017-08-01
影响因子：
24.7
通讯作者：
Abman, Steven H.
中科院分区：
文献类型：
--
作者：
Morrow, Lindsey A.;Wagner, Brandie D.;Abman, Steven H.
基本原理：导致早产后慢性肺部疾病的机制尚不完全清楚。目的：为了确定与早产后儿童早期支气管肺发育不良（BPD）和呼吸系统疾病风险增加相关的产前风险因素，我们对587例胎龄小于34周、出生体重在500和1,250 g之间的早产儿进行了前瞻性纵向研究。方法：收集的数据包括围产期的信息和评估新生儿重症监护病房入院和纵向随访问卷调查，直到2岁的age.Measurements和主要结果：调整协变量后，我们发现，母亲吸烟早产前增加的几率有一个婴儿与BPD的两倍（P = 0.02）。母亲吸烟与新生儿重症监护病房住院期间长时间机械通气和呼吸支持相关。既往存在的高血压与BPD的几率增加2倍（P = 0.04）相关。较低的胎龄和出生体重z评分与BPD相关。暴露于母亲吸烟的早产儿在儿童期晚期呼吸道疾病的发病率较高。22%的婴儿诊断为BPD和34%的早产儿没有BPD没有晚期呼吸道疾病的临床体征在早期childhood.Conclusions：我们的结论是，母亲吸烟和高血压增加早产后发展BPD的几率，和母亲吸烟与晚期呼吸道疾病的几率增加在幼儿期密切相关。这些发现表明，除了36周时的BPD诊断外，其他因素也会调节儿童期晚期呼吸结果。我们推测，减少母亲吸烟的措施不仅会降低早产的风险，而且会改善早产后的晚期呼吸道疾病。
Rationale: Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood.Objectives: To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, longitudinal study of 587 preterm infants with gestational age less than 34 weeks and birth weights between 500 and 1,250 g.Methods: Data collected included perinatal information and assessments during the neonatal intensive care unit admission and longitudinal follow-up by questionnaire until 2 years of age.Measurements and Main Results: After adjusting for covariates, we found that maternal smoking prior to preterm birth increased the odds of having an infant with BPD by twofold (P = 0.02). Maternal smoking was associated with prolonged mechanical ventilation and respiratory support during the neonatal intensive care unit admission. Preexisting hypertension was associated with a twofold (P = 0.04) increase in odds for BPD. Lower gestational age and birth weight z-scores were associated with BPD. Preterm infants who were exposed to maternal smoking had higher rates of late respiratory disease during childhood. Twenty-two percent of infants diagnosed with BPD and 34% of preterm infants without BPD had no clinical signs of late respiratory disease during early childhood.Conclusions: We conclude that maternal smoking and hypertension increase the odds for developing BPD after preterm birth, and that maternal smoking is strongly associated with increased odds for late respiratory morbidities during early childhood. These findings suggest that in addition to the BPD diagnosis at 36 weeks, other factors modulate late respiratory outcomes during childhood. We speculate that measures to reduce maternal smoking not only will lower the risk for preterm birth but also will improve late respiratory morbidities after preterm birth.