Objective: To investigate the risk factors associated with post-prematurity respiratory disease (PPRD) in very preterm infants. Methods: A prospective cohort study was conducted, enrolling 369 very preterm infants who were admitted to the neonatal intensive care unit of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, within one week of birth from January 2019 to June 2023. Data on maternal and infant clinical characteristics, neonatal morbidities, and treatments during hospitalization were collected. The very preterm infants were divided into 2 groups based on whether they developed PPRD. Continuous variables were compared using Mann-Whitney U test, while categorical variables were compared using χ² tests or continuity correction χ2 test. Multivariate Logistic regression analysis was used to identify the independent risk factors for PPRD in very preterm infants. Results: Among the 369 very preterm infants, 217 cases(58.8%) were male, with a gestational age of 30 (28, 31) weeks at birth and a birth weight of 1 320 (1 085, 1 590) g. Of these, 116 cases (31.4%) developed PPRD, while 253 cases (68.6%) did not. The very preterm infants in the PPRD group had a lower gestational age and lower birth weight (both, P<0.001). The PPRD group also had a higher proportion of males, lower Apgar scores at the 1st minute after birth and the 5th minutes after birth, a higher rate of born via cesarean delivery, and a higher incidence of bronchopulmonary dysplasia, more pulmonary surfactant treatment, longer durations of mechanical ventilation, longer total oxygen therapy, and lower Z-score for weight at discharge (all P<0.05). Multivariate Logistic regression analysis showed that gestational age (OR=0.85, 95%CI 0.73-0.99, P=0.037), born via cesarean delivery (OR=2.23, 95%CI 1.21-4.10, P=0.010), a duration of mechanical ventilation ≥7 days (OR=2.51, 95%CI 1.43-4.39, P=0.001), and a Z-score for weight at discharge (OR=0.82, 95%CI 0.67-0.99, P=0.040) were all independent risk factors for PPRD in very preterm infants. Conclusion: Very preterm infants with a small gestational age, born via cesarean section, mechanical ventilation ≥7 days, and a low Z-score for weight at discharge should be closely monitored for PPRD, and provided with standardized respiratory management after discharge.
目的： 探讨极早产儿合并早产后呼吸疾病（PPRD）的危险因素。 方法： 前瞻性队列研究。纳入2019年1月至2023年6月生后1周内于上海交通大学医学院附属新华医院新生儿重症监护病房住院的369例极早产儿，分析极早产儿校正年龄1岁内的呼吸系统疾病情况，并收集极早产儿和母亲的临床特征、早产儿并发症及相关治疗情况。根据是否合并PPRD将极早产儿分为PPRD组和无PPRD组。采用Mann Whitney U检验、χ2检验或连续校正χ2检验进行组间比较，应用多因素Logistic回归分析探讨PPRD的危险因素。 结果： 369例极早产儿中男217例（58.8%），出生胎龄为30（28，31）周，出生体重为1 320（1 085，1 590）g，116例（31.4%）合并PPRD，253例（68.6%）未合并PPRD。PPRD组极早产儿的出生胎龄和出生体重均低于无PPRD组（均P<0.001）。与无PPRD组相比，PPRD组男性更多，第1、5分钟Apgar评分均更低，剖宫产出生、支气管肺发育不良、应用肺表面活性物质治疗的极早产儿均更多，有创机械通气天数和总氧疗天数均更长，出院时年龄的体重Z评分更低，差异均有统计学意义（均P<0.05）。多因素Logistic回归分析显示，出生胎龄（OR=0.85，95%CI 0.73~0.99，P=0.037）、剖宫产出生（OR=2.23，95%CI 1.21~4.10，P=0.010）、有创机械通气天数≥7 d（OR=2.51，95%CI 1.43~4.39，P=0.001）和出院时年龄的体重Z评分（OR=0.82，95%CI 0.67~0.99，P=0.040）均是PPRD的独立危险因素。 结论： 对于出生胎龄小、剖宫产出生、有创机械通气天数≥7 d及出院时年龄的体重Z评分低的极早产儿，出院后应密切观察是否合并PPRD，并给予规范的呼吸管理。.