Predictive Value of Hemodynamic Indicators for Bronchopulmonary Dysplasia in Preterm Infants

Abstract

BackgroundIn China, the growing prevalence of bronchopulmonary dysplasia (BPD) in increased number of survived very preterm and extremely preterm infants, seriously endangers the life and impairs quality of life in this population. There are different degrees of hemodynamic changes in preterm infants in the process of developing BPD, however, there are relatively few studies about the correlation between the occurrence of BPD and hemodynamic indicators in preterm infant.ObjectiveTo examine predictive value of the hemodynamic indexes for BPD in premature infants.MethodsOne hundred and sixty-one premature infants (hospitalized within 1 hour of birth, gestational age <32 weeks) were selected from Xinxiang Central Hospital from September 2018 to December 2020. The general data (gestational age, birth weight, sex, and mode of delivery) were collected; the basic diseases and other complications of preterm infants were collected, compared between two groups of infants divided by the prevalence of BPD (n=65) or not (n=96) . PI values (measured at 1, 12, 48, 72 and 96 hours after delivery, and on the 5th, 6th, and 7th days after delivery, respectively) , and serum lactic acid levels (measured at 1, 12, and 24 hours after admission, respectively) were collected. Mean arterial pressure (MAP) levels measured by arterial pressure monitoring at 1, 12 and 24 hours after admission for 33 infants (16 in BPD group and 17 in the control group) with critical or extremely critical conditions suggested by neonatal critical illness score were also collected. Compare the results between two groups, the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of PI, serum lactic acid and MAP for BPD in preterm infants.ResultsSixty-five out of the 161 cases 〔40.3% (65/161) 〕were diagnosed with BPD. Preterm infants with and without BPD had no statistically significant differences in gestational age, birth weight, gender, and mode of delivery (P>0.05) . Preterm infants with BPD had higher incidence of neonatal asphyxia, neonatal respiratory distress syndrome, neonatal pneumonia, and retinopathy of prematurity than those without (P<0.05) . Preterm infants with and without BPD had no statistically significant differences in sepsis, pulmonary hemorrhage, PDA, IVH, purulent meningitis and anemia (P>0.05) . PI values at 1, 12 and 24 hours after birth differed significantly between the two groups (P<0.05) . Serum lactic acid at 1 hour after admission differed significant between the two groups (P<0.05) . MAP levels at different time periods showed no significant differences between critical and extremely critical preterm infants with and without BPD (P>0.05) . In predicting BPD, the PI at 1-hour, 12-hour, and 24-hour was 0.847〔95%CI (0.788, 0.906) , P<0.001〕, 0.776〔95%CI (0.705, 0.846) , P<0.001〕, 0.695〔95%CI (0.613, 0.778) , P<0.001〕, respectively; the optimal cutoff value was chosen as 0.55, 1.15, 1.45, with the sensitivity of 76.9%, 86.2%, 81.5% and the specificity of 75.0%, 60.4%, 51.0%; serum lactic acid at 1 hour after birthhad an AUC of 0.762〔95%CI (0.686, 0.837) , P<0.001〕, the optimal cutoff value was chosen as 6.55, with the sensitivity of 81.5%, and the specificity of 68.7%.ConclusionIn preterm infants with a gestational age <32 weeks, the change of hemodynamic indicatou PI and lactic acid value maybe correlated with the occurrence of BPD. PI value within 24 hours after birth may be an earlypredictor for BPD, but further research is still needed.

Keywords

• |bronchopulmonary dysplasia|infant, remature|hemodynamics|perfusion index|lactic acid|mean arterial pressure|forecasting