Assessment of risk factors for bronchopulmonary dysplasia with pulmonary hypertension and construction of a prediction nomogram model.
10.3760/cma.j.cn112140-20230616-00406
- Author:
Shu Zhen DAI
1
;
Shu Shu LI
2
;
Mei Yun ZHOU
3
;
Yan XU
4
;
Lin ZHANG
5
;
Yu Han ZHANG
6
;
Dan Ni YE
7
;
Li Ping XU
1
;
Shu Ping HAN
2
Author Information
1. Department of Neonatology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China.
2. Department of Neonatology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, China.
3. Department of Neonatology, Nantong Maternal and Child Health Hospital, Nantong 226001, China.
4. Department of Neonatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China.
5. Department of Neonatology, Changzhou Maternal and Child Health Care Hospital, Changzhou 213003, China.
6. Department of Neonatology, Jiangsu Maternal and Child Health Care Hospital, Nanjing 210036, China.
7. Department of Neonatology, Wuxi Maternal and Child Health Care Hospital, Wuxi 214002, China.
- Publication Type:Journal Article
- MeSH:
Infant;
Male;
Infant, Newborn;
Humans;
Pregnancy;
Female;
Bronchopulmonary Dysplasia/epidemiology*;
Infant, Premature;
Hypertension, Pulmonary/epidemiology*;
Retrospective Studies;
Nomograms;
Ductus Arteriosus, Patent/epidemiology*;
Pneumonia, Ventilator-Associated/complications*;
Cesarean Section/adverse effects*;
Gestational Age;
Risk Factors;
Sepsis
- From:
Chinese Journal of Pediatrics
2023;61(10):902-909
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To explore the risk factors of pulmonary hypertension (PH) in premature infants with bronchopulmonary dysplasia (BPD), and to establish a prediction model for early PH. Methods: This was a retrospective cohort study. Data of 777 BPD preterm infants with the gestational age of <32 weeks were collected from 7 collaborative units of the Su Xinyun Neonatal Perinatal Collaboration Network platform in Jiangsu Province from January 2019 to December 2022. The subjects were randomly divided into a training cohort and a validation cohort at a ratio of 8∶2 by computer, and non-parametric test or χ2 test was used to examine the differences between the two retrospective cohorts. Univariate Logistic regression and multivariate logistic regression analyses were used in the training cohort to screen the risk factors affecting the PH associated with BPD. A nomogram model was constructed based on the severity of BPD and its risk factors,which was internally validated by the Bootstrap method. Finally, the differential, calibration and clinical applicability of the prediction model were evaluated using the training and verification queues. Results: A total of 130 among the 777 preterm infants with BPD had PH, with an incidence of 16.7%, and the gestational age was 28.7 (27.7, 30.0) weeks, including 454 males (58.4%) and 323 females (41.6%). There were 622 preterm infants in the training cohort, including 105 preterm infants in the PH group. A total of 155 patients were enrolled in the verification cohort, including 25 patients in the PH group. Multivariate Logistic regression analysis revealed that low 5 min Apgar score (OR=0.87, 95%CI 0.76-0.99), cesarean section (OR=1.97, 95%CI 1.13-3.43), small for gestational age (OR=9.30, 95%CI 4.30-20.13), hemodynamically significant patent ductus arteriosus (hsPDA) (OR=4.49, 95%CI 2.58-7.80), late-onset sepsis (LOS) (OR=3.52, 95%CI 1.94-6.38), and ventilator-associated pneumonia (VAP) (OR=8.67, 95%CI 3.98-18.91) were all independent risk factors for PH (all P<0.05). The independent risk factors and the severity of BPD were combined to construct a nomogram map model. The area under the receiver operating characteristic (ROC) curve of the nomogram model in the training cohort and the validation cohort were 0.83 (95%CI 0.79-0.88) and 0.87 (95%CI 0.79-0.95), respectively, and the calibration curve was close to the ideal diagonal. Conclusions: Risk of PH with BPD increases in preterm infants with low 5 minute Apgar score, cesarean section, small for gestational age, hamodynamically significant patent ductus arteriosus, late-onset sepsis, and ventilator-associated pneumonia. This nomogram model serves as a useful tool for predicting the risk of PH with BPD in premature infants, which may facilitate individualized early intervention.
