Association of Atrial Septal Defects and Bronchopulmonary Dysplasia in Premature Infants
Association of Atrial Septal Defects and Bronchopulmonary Dysplasia in Premature Infants
复制标题
DOI：
10.1016/j.jpeds.2018.07.024
复制
发表时间：
2018-11-01
影响因子：
5.1
通讯作者：
Hornik, Christoph P.
中科院分区：
文献类型：
--
作者：
Kumar, Karan R.;Clark, David A.;Hornik, Christoph P.
目的探讨房间隔缺损（ASD）与早产儿支气管肺发育不良（BPD）的关系。研究设计我们选取了2004年至2016年从新生儿重症监护病房出院的至少一次超声心动图评估、出生体重501-1249 g、胎龄23-30周的婴儿队列。我们使用BPD风险估计器来计算出生后28天内6岁时发生BPD的预测风险。我们使用2个多变量逻辑回归模型对每个出生日后的每个BPD风险严重程度进行了ASD存在与BPD发展之间的关系的检验。第一个模型调整了预测的BPD风险，第二个模型增加了BPD的治疗干预措施。结果228例新生儿重症监护病房的20496例符合纳入标准的婴儿中，8892例（43%）诊断为BPD， 1314例（6%）诊断为ASD。有自闭症的婴儿中有48%存在BPD，无自闭症的婴儿中有43%存在BPD。在患有ASD的婴儿中，无论出生后年龄或预测的BPD风险严重程度如何，在调整BPD的预测风险加上治疗干预后，发生BPD的OR更高。结论：在该队列中，ASD的存在与BPD的几率增加有关。未来的试验应该考虑到ASD在这一弱势人群中是一个潜在的可改变的危险因素。
Objective To evaluate the association between the presence of an atrial septal defect (ASD) and the odds of developing bronchopulmonary dysplasia (BPD) in premature infants.Study design We identified a cohort of infants that underwent at least one echocardiogram assessment, birth weight 501-1249 g, and gestational age 23-30 weeks discharged from the neonatal intensive care unit from 2004 to 2016. We used a BPD risk estimator to calculate the predicted risk of developing BPD at 6 postnatal ages within the first 28 days of life. We examined the association between the presence of an ASD and the development of BPD using 2 multivariable logistic regression models for each BPD risk severity on each postnatal day. The first model adjusted for predicted BPD risk and the second added therapeutic interventions for BPD.Results Of 20 496 infants from 228 NICUs who met inclusion criteria, 8892 (43%) were diagnosed with BPD and 1314 (6%) had an ASD. BPD was present in 48% of infants with an ASD and 43% of infants without an ASD. In infants with an ASD, the OR of developing BPD was higher after adjusting for predicted risk of BPD plus therapeutic interventions, regardless of postnatal age or predicted BPD risk severity.Conclusions The presence of an ASD was associated with an increased odds of BPD in this cohort. Future trials should consider ASD as a potentially modifiable risk factor in this vulnerable population.