Risk factors for bronchopulmonary dysplasia and construction of a prediction model in very/extremely preterm infants

doi:10.11958/20253697

Abstract

Abstract:

Objective To explore risk factors of bronchopulmonary dysplasia (BPD) in very/extremely preterm infants and construct the prediction model. Methods A total of 206 very/extremely preterm infants were selected and divided into the BPD group (101 cases) and the non-BPD group (105 cases). The differences in perinatal and neonatal clinical data were compared between the two groups. Logistic regression analysis was used to analyze influencing factors of BPD occurrence and construct a prediction model. The receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the model. Internal validation of the model was conducted by Bootstrap method (repeated sampling for 1000 times). The predictive value of the model for the severity of BPD was further evaluated by ROC curve. Results The proportion of intrauterine infection during pregnancy was higher in the BPD group than that in the non-BPD group (P<0.05). The comparison of early neonatal factors showed that the proportion of gestational age < 28 weeks, neonatal respiratory distress syndrome, patent ductus arteriosus, infectious pneumonia, and invasive mechanical ventilation time >7 d were significantly higher in the BPD group than those in the non-BPD group (P<0.05). Multivariate Logistic regression analysis showed that intrauterine infection during pregnancy (OR=6.846, 95%CI: 1.757-26.667), gestational age <28 weeks (OR=4.241, 95%CI: 2.072-8.683), neonatal respiratory distress syndrome (OR=6.346, 95%CI: 3.003-13.411), patent ductus arteriosus (OR=4.935, 95%CI: 1.919-12.695), infectious pneumonia (OR=3.323, 95%CI: 1.465-7.540) and invasive mechanical ventilation time >7 d (OR=4.954, 95%CI: 2.226-11.025) were independent risk factors for BPD in very/extremely premature infants (P<0.01). The combined prediction model was constructed based on the above influencing factors, and its goodness of fit was detected by Hosmer-Lemeshow test (χ²=8.433, P=0.296). The area under the curve (AUC) of the model for predicting BPD was 0.837 (95%CI: 0.783-0.891), AUC of internal validation was 0.814 (95%CI: 0.754-0.875), and AUC of the model for predicting severe BPD was 0.874 (95%CI: 0.816-0.933). Conclusion The risk prediction model of BPD constructed based on prenatal and postnatal data has good discrimination and calibration in very/extremely preterm infants, which is conducive to early clinical intervention.

Key words: premature infant, bronchopulmonary dysplasia, risk factor, prediction

CLC Number:

R722.6，R563.9

Figures/Tables 6

References 24

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组别	n		母亲年龄				妊娠期高血压		妊娠期糖尿病	孕期宫内感染
组别	n		<35岁		≥35岁		妊娠期高血压		妊娠期糖尿病	孕期宫内感染
非BPD组	105		74（70.5）		31（29.5）		12（11.4）		6（5.7）	4（3.8）
BPD组	101		67（66.3）		34（33.7）		13（12.9）		6（5.9）	13（12.9）
χ²			0.408				0.100		0.005	5.830^＊
组别		羊水胎粪污染		胎膜早破		胎儿窘迫		分娩方式
组别		羊水胎粪污染		胎膜早破		胎儿窘迫		阴道分娩			剖宫产
非BPD组		4（3.8）		37（35.2）		8（7.6）		52（49.5）			53（50.5）
BPD组		6（5.9）		39（38.6）		7（6.9）		45（44.6）			56（55.4）
χ²		0.506		0.252		0.036		0.510

组别	n		母亲年龄				妊娠期高血压		妊娠期糖尿病	孕期宫内感染
组别	n		<35岁		≥35岁		妊娠期高血压		妊娠期糖尿病	孕期宫内感染
非BPD组	105		74（70.5）		31（29.5）		12（11.4）		6（5.7）	4（3.8）
BPD组	101		67（66.3）		34（33.7）		13（12.9）		6（5.9）	13（12.9）
χ²			0.408				0.100		0.005	5.830^＊
组别		羊水胎粪污染		胎膜早破		胎儿窘迫		分娩方式
组别		羊水胎粪污染		胎膜早破		胎儿窘迫		阴道分娩			剖宫产
非BPD组		4（3.8）		37（35.2）		8（7.6）		52（49.5）			53（50.5）
BPD组		6（5.9）		39（38.6）		7（6.9）		45（44.6）			56（55.4）
χ²		0.506		0.252		0.036		0.510

组别	n		性别			胎龄			新生儿呼吸窘迫综合征
组别	n		男	女		<28周		≥28周	新生儿呼吸窘迫综合征
非BPD组	105		56（53.3）	49（46.7）		38（36.2）		67（63.8）	41（39.0）
BPD组	101		49（48.5）	52（51.5）		61（60.4）		40（39.6）	67（66.3）
χ²			0.478			12.083^＊＊			15.371^＊＊
组别		动脉导管未闭			感染性肺炎		有创机械通气时间
组别		动脉导管未闭			感染性肺炎		≤7 d			>7 d
非BPD组		11（10.5）			16（15.2）		89（84.8）			16（15.2）
BPD组		25（24.8）			33（32.7）		63（62.4）			38（37.6）
χ²		7.275^＊＊			8.632^＊＊		13.338^＊＊

组别	n		性别			胎龄			新生儿呼吸窘迫综合征
组别	n		男	女		<28周		≥28周	新生儿呼吸窘迫综合征
非BPD组	105		56（53.3）	49（46.7）		38（36.2）		67（63.8）	41（39.0）
BPD组	101		49（48.5）	52（51.5）		61（60.4）		40（39.6）	67（66.3）
χ²			0.478			12.083^＊＊			15.371^＊＊
组别		动脉导管未闭			感染性肺炎		有创机械通气时间
组别		动脉导管未闭			感染性肺炎		≤7 d			>7 d
非BPD组		11（10.5）			16（15.2）		89（84.8）			16（15.2）
BPD组		25（24.8）			33（32.7）		63（62.4）			38（37.6）
χ²		7.275^＊＊			8.632^＊＊		13.338^＊＊

变量	β	SE	Wald χ²	P	OR	OR（95%CI）
孕期宫内感染	1.924	0.694	7.687	0.006	6.846	1.757~26.667
新生儿胎龄	1.445	0.366	15.621	<0.001	4.241	2.072~8.683
新生儿呼吸窘迫综合征	1.848	0.382	23.429	<0.001	6.346	3.003~13.411
动脉导管未闭	1.596	0.482	10.968	0.001	4.935	1.919~12.695
感染性肺炎	1.201	0.418	8.254	0.004	3.323	1.465~7.540
有创机械通气时间	1.600	0.409	15.374	<0.001	4.954	2.226~11.025
常数项	-2.820	0.447	39.800	<0.001	0.060