Zhongguo quanke yixue (Jan 2023)
Risk Factors for Bronchopulmonary Dysplasia in Premature Infants: a Meta-analysis
Abstract
Background Bronchopulmonary dysplasia (BPD) is the most common severe lung disease in premature infants, which is the damage to immature lung caused by multiple factors. Identifying risk factors of BPD is important for developing prevention strategies. The risk factors of BPD are still controversial, and there are few systematic reviews. Objective To systematically analyze the risk factors for BPD in preterm infants. Methods This study searched CNKI, Wanfang Data, CBM, VIP, PubMed, Embase, Web of Science and Cochrane Library for studies evaluating risk factors of BPD from inception to October 2021. We used RevMan 5.3 software to perform meta-analysis. Results We included 23 studies of 33 508 BPD premature infants. The overall NOS scores of included studies were relatively high. The results of meta-analysis showed that mother with chorioamnionitis〔OR=1.46, 95%CI (1.18, 1.80) , P=0.000 6〕, gestational hypertension〔OR=1.26, 95%CI (1.15, 1.37) , P<0.000 01〕, premature rupture of membranes〔OR=1.18, 95%CI (1.10, 1.26) , P<0.000 01〕, preterm infants with small for gestational age (SGA) 〔OR=2.64, 95%CI (1.85, 3.77) , P<0.000 01〕, delivery room intubation of preterm infants〔OR=2.50, 95%CI (1.39, 4.50) , P=0.002〕, premature 5 min Apgar score<7 points〔OR=2.47, 95%CI (1.36, 4.47) , P=0.003〕, male preterm infants〔OR=1.49, 95%CI (1.43, 1.55) , P<0.000 01〕, mechanical ventilation in preterm infants〔OR=1.59, 95%CI (1.28, 1.96) , P<0.000 1〕, mechanical ventilation in preterm infants>7 days〔OR=7.99, 95%CI (4.47, 14.29) , P<0.000 01〕, preterm infants treated with surfactant〔OR=3.46, 95%CI (1.96, 6.11) , P<0.000 1〕, steroids used in preterm infants〔OR=2.42, 95%CI (1.93, 3.03) , P<0.000 01〕, preterm infants with respiratory distress syndrome (RDS) 〔OR=3.40, 95%CI (2.01, 5.75) , P<0.000 01〕, preterm infants with patent ductus arteriosus (PDA) 〔OR=1.96, 95%CI (1.38, 2.79) , P=0.002〕, preterm infants with sepsis〔OR=1.82, 95%CI (1.36, 2.44) , P<0.000 1〕, preterm infants with necrotizing enterocolitis (NEC) 〔OR=1.62, 95%CI (1.18, 2.22) , P=0.003〕were risk factors for BPD in preterm infants. Preterm infants with high birth weight〔OR=0.79, 95%CI (0.76, 0.83) , P<0.000 01〕 and preterm infants with large gestational age〔OR=0.80, 95%CI (0.73, 0.87) , P<0.000 01〕were protective factors for BPD in preterm infants. Funnel plots, Begg's test and Egger's test showed that there was no publication bias (P>0.05) . Conclusion Current evidence showed that mother with chorioamnionitis, gestational hypertension, preterm rupture of membranes and preterm infants with SGA, delivery room intubation, 5 min Apgar score <7 points, male, mechanical ventilation, mechanical ventilation>7 days, administration of pulmonary surfactant, steroids, RDS, PDA, sepsis, NEC were risk factors for BPD in preterm infants. High birth weight and large gestational age were protective factors for BPD in preterm infants. Clinicians should identify and address the relevant risk factors of BPD, thus preventing the BPD in premature infants.
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