PDF(Pubmed)
Abstract：
BACKGROUND: Recent attempts to refine the definition bronchopulmonary dysplasia (BPD) have based its predictive capacity on respiratory outcome in the first 2 years of life, eliminating the pre-existing requirement of 28 days of oxygen therapy prior to 36 weeks postmenstrual age (PMA). The objective of this study was to assess the utility of the 2001 consensus definition in predicting impaired lung function at preschool age.
METHODS: This cohort study included children aged 4-6 years old who were born at gestational age (GA) <32 weeks or bodyweight <1500 g. Univariate and multivariate analyses were performed to assess differences in antenatal and neonatal variables between BPD and non-BPD children. All participants underwent incentive spirometry. Lung function parameters were contrasted with the Global Lung Function Initiative (GLI-2012) reference equations and, together with antenatal and neonatal variables, compared among the different subgroups (no BPD, mild BPD, and moderate-to-severe BPD). A multivariate model was generated to identify independent risk factors for impaired lung function.
RESULTS: GA, hemodynamically significant patent ductus arteriosus, and late sepsis were independent risk factors for the development of BPD. A total of 119 children underwent incentive spirometry. All lung function parameters were significantly altered relative to reference values. Greater impairment of lung function was observed in the mild BPD vs. the no BPD group (forced expiratory volume in the first 0.75 seconds [FEV0.75]: -1.18 ± 0.80 vs. -0.55 ± 1.13; p = 0.010), but no difference in forced vital capacity (FVC) was observed (-0.32 ± 0.90 vs. -0.18 ± 1; p = 0.534). The moderate-to-severe BPD group exhibited the most severe FEV0.75 reduction (FEV0.75: -2.63 ± 1.18 vs. -0.72 ± 1.08; p = 0.000) and was the only condition with FVC impairment (FVC: -1.82 ± 1.12 vs. -0.22 ± 0.87; p = 0.000). The multivariate analysis identified a diagnosis of moderate-to-severe BPD as an independent risk factor for lung function impairment.
CONCLUSIONS: The 2001 consensus definition of BPD has adequate predictive capacity for lung function measured by spirometry at 4-6 years of age. Moderate-to-severe BPD was the best predictor of respiratory impairment. Children with mild BPD showed greater alteration of FEV0.75 than those without BPD.
METHODS: This cohort study included children aged 4-6 years old who were born at gestational age (GA) <32 weeks or bodyweight <1500 g. Univariate and multivariate analyses were performed to assess differences in antenatal and neonatal variables between BPD and non-BPD children. All participants underwent incentive spirometry. Lung function parameters were contrasted with the Global Lung Function Initiative (GLI-2012) reference equations and, together with antenatal and neonatal variables, compared among the different subgroups (no BPD, mild BPD, and moderate-to-severe BPD). A multivariate model was generated to identify independent risk factors for impaired lung function.
RESULTS: GA, hemodynamically significant patent ductus arteriosus, and late sepsis were independent risk factors for the development of BPD. A total of 119 children underwent incentive spirometry. All lung function parameters were significantly altered relative to reference values. Greater impairment of lung function was observed in the mild BPD vs. the no BPD group (forced expiratory volume in the first 0.75 seconds [FEV0.75]: -1.18 ± 0.80 vs. -0.55 ± 1.13; p = 0.010), but no difference in forced vital capacity (FVC) was observed (-0.32 ± 0.90 vs. -0.18 ± 1; p = 0.534). The moderate-to-severe BPD group exhibited the most severe FEV0.75 reduction (FEV0.75: -2.63 ± 1.18 vs. -0.72 ± 1.08; p = 0.000) and was the only condition with FVC impairment (FVC: -1.82 ± 1.12 vs. -0.22 ± 0.87; p = 0.000). The multivariate analysis identified a diagnosis of moderate-to-severe BPD as an independent risk factor for lung function impairment.
CONCLUSIONS: The 2001 consensus definition of BPD has adequate predictive capacity for lung function measured by spirometry at 4-6 years of age. Moderate-to-severe BPD was the best predictor of respiratory impairment. Children with mild BPD showed greater alteration of FEV0.75 than those without BPD.
摘要：
背景：最近试图完善支气管肺发育不良（BPD）的定义，其预测能力基于生命最初2年的呼吸结局，消除了月经后36周龄（PMA）之前28天的氧气治疗要求。这项研究的目的是评估2001年共识定义在预测学龄前肺功能受损方面的实用性。
方法：这项队列研究包括4-6岁的儿童，他们出生在胎龄（GA）<32周或体重<1500g。进行单变量和多变量分析以评估BPD和非BPD儿童在产前和新生儿变量方面的差异。所有参与者都接受了激励肺活量测定。将肺功能参数与全球肺功能倡议(GLI-2012)参考方程进行对比，连同产前和新生儿变量，不同亚组之间的比较(无BPD，轻度BPD,和中度至重度BPD）。建立多变量模型以确定肺功能受损的独立危险因素。
结果：GA，血流动力学显著动脉导管未闭，晚期脓毒症是BPD发生的独立危险因素。共有119名儿童接受了激励肺活量测定。所有肺功能参数相对于参考值均显着改变。在轻度BPD与轻度BPD中观察到肺功能更大的损害无BPD组（前0.75秒用力呼气量[FEV0.75]：-1.18±0.80vs.-0.55±1.13；p=0.010），但没有观察到强迫肺活量（FVC）的差异（-0.32±0.90vs.-0.18±1；p=0.534）。中重度BPD组表现出最严重的FEV0.75降低（FEV0.75：-2.63±1.18vs.-0.72±1.08；p=0.000），并且是FVC受损的唯一条件（FVC：-1.82±1.12vs.-0.22±0.87；p=0.000）。多变量分析确定了中度至重度BPD的诊断为肺功能损害的独立危险因素。
结论：2001年BPD的共识定义对4-6岁时通过肺活量测定法测量的肺功能具有足够的预测能力。中度至重度BPD是呼吸损害的最佳预测指标。轻度BPD的儿童比没有BPD的儿童表现出更大的FEV0.75变化。
方法：这项队列研究包括4-6岁的儿童，他们出生在胎龄（GA）<32周或体重<1500g。进行单变量和多变量分析以评估BPD和非BPD儿童在产前和新生儿变量方面的差异。所有参与者都接受了激励肺活量测定。将肺功能参数与全球肺功能倡议(GLI-2012)参考方程进行对比，连同产前和新生儿变量，不同亚组之间的比较(无BPD，轻度BPD,和中度至重度BPD）。建立多变量模型以确定肺功能受损的独立危险因素。
结果：GA，血流动力学显著动脉导管未闭，晚期脓毒症是BPD发生的独立危险因素。共有119名儿童接受了激励肺活量测定。所有肺功能参数相对于参考值均显着改变。在轻度BPD与轻度BPD中观察到肺功能更大的损害无BPD组（前0.75秒用力呼气量[FEV0.75]：-1.18±0.80vs.-0.55±1.13；p=0.010），但没有观察到强迫肺活量（FVC）的差异（-0.32±0.90vs.-0.18±1；p=0.534）。中重度BPD组表现出最严重的FEV0.75降低（FEV0.75：-2.63±1.18vs.-0.72±1.08；p=0.000），并且是FVC受损的唯一条件（FVC：-1.82±1.12vs.-0.22±0.87；p=0.000）。多变量分析确定了中度至重度BPD的诊断为肺功能损害的独立危险因素。
结论：2001年BPD的共识定义对4-6岁时通过肺活量测定法测量的肺功能具有足够的预测能力。中度至重度BPD是呼吸损害的最佳预测指标。轻度BPD的儿童比没有BPD的儿童表现出更大的FEV0.75变化。
