Synergistic effects of achieving perinatal interventions on bronchopulmonary dysplasia in preterm infants

期刊论文
发表日期：

2024年1月17日

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Xiang Chen,
Lin Yuan,
Siyuan Jiang,
Xinyue Gu,
Xiaoping Lei,
Liyuan Hu,
Tiantian Xiao,
Yanping Zhu,
Dan Dang,
Wenli Li,
Yun Cao,
Lizhong Du,
Shoo K. Lee,
Chao Chen,
Wenhao Zhou,
Jianguo Zhou,
Yulan Lu,
Tongling Yang,
Jie Yang,
Hao Yuan,
Li Wang,
Lin Yuan,
Shoo K. Lee,
Chao Chen,
Lizhong Du,
Wenhao Zhou,
Yun Cao,
Xiuyong Cheng,
Huayan Zhang,
Xiuying Tian,
Jingyun Shi,
Zhankui Li,
Chuanzhong Yang,
Ling Liu,
Zuming Yang,
Jianhua Fu,
Yong Ji,
Dongmei Chen,
Changyi Yang,
Rui Chen,
Xiaoming Peng,
Ruobing Shan,
Shuping Han,
Hui Wu,
Lili Wang,
Qiufen Wei,
Mingxia Li,
Yiheng Dai,
Hong Jiang,
Wenqing Kang,
Xiaohui Gong,
Xiaoyun Zhong,
Yuan Shi,
Shanyu Jiang,
Bin Sun,
Long Li,
Zhenlang Lin,
Jiangqin Liu,
Jiahua Pan,
Hongping Xia,
Xiaoying Li,
Falin Xu,
Yinping Qiu,
Li Ma,
Ling Yang,
Xiaori He,
Yanhong Li,
Deyi Zhuang,
Qin Zhang,
Wenbin Dong,
Jianhua Sun,
Kun Liang,
Huaiyan Wang,
Jinxing Feng,
Xinzhu Lin,
Chunming Jiang,
Chuan Nie,
Lingkong Zeng,
Mingyan Hei,
Hongdan Zhu,
Hongying Mi,
Zhaoqing Yin,
Hongxia Song,
Hongyun Wang,
Jinyuan Wang,
Yan Gao,
Yajuan Wang,
Liying Dai,
Liyan Zhang,
Yangfang Li,
Qianshen Zhang,
Guofang Ding,
Jimei Wang,
Xiaoxia Chen,
Zhen Wang,
Zheng Tang,
Xiaolu Ma,
Xiaomei Zhang,
Xiaolan Zhang,
Fang Wu,
Yanxiang Chen,
Ying Wu,
Joseph Ting

摘要

To investigate the effect of perinatal interventions on the risk of severe BPD (sBPD) and death in extremely preterm infants (EPIs) and their synergistic effects. This was a secondary analysis of the prospective cohort Chinese Neonatal Network (CHNN). Infants with a birth weight of 500 to 1250 g or 24–28 weeks completed gestational age were recruited. The impacts and the synergistic effects of six evidence-based perinatal interventions on the primary outcomes of sBPD and death were assessed by univariate and multivariable logistic regression modeling. Totally, 6568 EPIs were finally enrolled. Antenatal corticosteroid (adjusted OR, aOR, 0.74; 95%CI, 0.65–083), birth in centers with tertiary NICU (aOR, 0.64; 95%CI, 0.57–0.72), preventing intubation in the delivery room (aOR, 0.65; 95%CI, 0.58–0.73), early caffeine therapy (aOR, 0.59; 95%CI, 0.52–0.66), and early extubating (aOR, 0.42; 95%CI 0.37–0.47), were strongly associated with a lower risk of sBPD and death while early surfactant administration was associated with a lower risk of death (aOR, 0.84; 95%CI, 0.72, 0.98). Compared with achieving 0/1 perinatal interventions, achieving more than one intervention was associated with decreased rates (46.6% in 0/1 groups while 38.5%, 29.6%, 22.2%, 16.2%, and 11.7% in 2/3/4/5/6-intervention groups respectively) and reduced risks of sBPD/death with aORs of 0.76(0.60, 0.96), 0.55(0.43, 0.69), 0.38(0.30, 0.48), 0.28(0.22, 0.36), and 0.20(0.15, 0.27) in 2, 3, 4, 5, and 6 intervention groups respectively. Subgroup analyses showed consistent results.

Conclusion: Six perinatal interventions can effectively reduce the risk of sBPD and death in a synergistic form.

What is Known:

• Bronchopulmonary dysplasia (BPD) is a multifactorial chronic lung disease associated with prematurity. The effective management of BPD requires a comprehensive set of interventions. However, the extent to which these interventions can mitigate the risk of severe outcomes, such as severe BPD or mortality, or if they possess synergistic effects remains unknown.

What is New:

• The implementation of various perinatal interventions, such as prenatal steroids, birth in centers with tertiary NICU, early non-Invasive respiratory support, surfactant administration within 2 hours after birth, early caffeine initiation within 3 days, and early extubation within 7 days after birth has shown promising results in the prevention of severe bronchopulmonary dysplasia (BPD) or mortality in extremely preterm infants. Moreover, these interventions have demonstrated synergistic effects when implemented in combination.