极早产儿的呼吸轨迹和死亡或中重度支气管肺发育不良的风险：一项为期九年的队列研究
Respiratory trajectory and risk of death or moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a nine-year cohort study.
摘要(中文译文)
评估极早产儿在矫正胎龄36周前死亡或发生中重度支气管肺发育不良（BPD）的相关因素，同时校正幸存者偏倚。本回顾性队列研究纳入2017年1月至2025年12月期间入住三级新生儿重症监护病房、出生胎龄<32周的婴儿。主要结局为矫正胎龄36周前死亡或中重度BPD。研究考察了基线特征、新生儿疾病及呼吸支持变量。采用序贯建模方法进行多变量logistic回归，依次纳入早期临床变量和后续呼吸病程变量。在1,259名婴儿中，1,253名具有完整结局数据并纳入分析；复合结局发生率为27.1%。风险随胎龄增加而逐步降低，从<26周出生婴儿的80.2%降至30-31周的11.7%（<0.001）。胎龄每增加一周，复合结局的比值降低（aOR：0.85，95% CI：0.77-0.94）。在完全校正模型中，有创通气的累积持续时间（每7天aOR：1.29，95% CI：1.14-1.45）和HFOV暴露（aOR：1.79，95% CI：1.15-2.79）与复合结局相关，尽管HFOV的相关性可能反映了更严重的潜在呼吸疾病严重程度及支持升级。纳入呼吸病程变量后，感染相关变量的相关性减弱。模型区分度从0.807提高至0.841。在极早产儿中，较低胎龄和延长有创通气是与死亡或中重度BPD相关的主要因素。涉及呼吸升级治疗的相关性可能反映了更严重的潜在疾病严重程度及不断演变的呼吸病程。
Abstract
To evaluate factors associated with death before 36 weeks' postmenstrual age (PMA) or moderate-to-severe bronchopulmonary dysplasia (BPD) in very preterm infants while accounting for survivor bias. This retrospective cohort study included infants born at <32 weeks' gestation and admitted to a tertiary neonatal intensive care unit between January 2017 and December 2025. The primary outcome was death before 36 weeks' PMA or moderate-to-severe BPD. Baseline characteristics, neonatal morbidities, and respiratory support variables were examined. Multivariable logistic regression was performed using a sequential modelling approach incorporating early clinical variables and subsequent respiratory-course variables. Among 1,259 infants, 1,253 had complete outcome data and were included in the analysis; the composite outcome occurred in 27.1%. Risk decreased progressively with advancing gestational age, from 80.2% in infants born at <26 weeks to 11.7% at 30-31 weeks ( < 0.001). Each additional week of gestation was associated with lower odds of the composite outcome (aOR: 0.85, 95% CI: 0.77-0.94). In the fully adjusted model, cumulative duration of invasive ventilation (aOR: 1.29 per 7 days, 95% CI: 1.14-1.45) and HFOV exposure (aOR: 1.79, 95% CI: 1.15-2.79) were associated with the composite outcome, although the association with HFOV likely reflected greater underlying respiratory illness severity and escalation of support. Associations involving infection-related variables were attenuated after inclusion of respiratory-course variables. Model discrimination improved from 0.807 to 0.841. In very preterm infants, lower gestational age and prolonged invasive ventilation were the principal factors associated with death or moderate-to-severe BPD. Associations involving respiratory escalation therapies likely reflected greater underlying illness severity and evolving respiratory trajectory.
如何引用
AMA
Talal Aljarbou, Abdulaziz Homedi, Saad Alshareedah, Maather Almutairi, Moudhi Alhumaidi, Nouf Alayyar, et al. Respiratory trajectory and risk of death or moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a nine-year cohort study.. Frontiers in pediatrics. 2026; doi:10.3389/fped.2026.1843270.
APA
Talal Aljarbou, Abdulaziz Homedi, Saad Alshareedah, Maather Almutairi, Moudhi Alhumaidi, Nouf Alayyar, et al (2026). Respiratory trajectory and risk of death or moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a nine-year cohort study.. Frontiers in pediatrics. https://doi.org/10.3389/fped.2026.1843270
GB/T 7714
Talal Aljarbou, Abdulaziz Homedi, Saad Alshareedah, Maather Almutairi, Moudhi Alhumaidi, Nouf Alayyar, et al. Respiratory trajectory and risk of death or moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a nine-year cohort study.[J]. Frontiers in pediatrics, 2026 doi:10.3389/fped.2026.1843270.
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