Risk factors for bronchopulmonary dysplasia in twin preterm infants: a multicenter study

FAN Yu-Wei; ZHANG Yi-Jia; WEN He-Mei; YAN Hong; SHEN Wei; DING Yue-Qin; LONG Yun-Feng; ZHANG Zhi-Gang; LI Gui-Fang; JIANG Hong; RAO Hong-Ping; QIU Jian-Wu; WEI Xian; ZHANG Ya-Yu; ZENG Ji-Bin; ZHAO Chang-Liang; XU Wei-Peng; WANG Fan; YUAN Li; YANG Xiu-Fang; LI Wei; LIN Ni-Yang; CHEN Qian; XIA Chang-Shun; ZHONG Xin-Qi; CUI Qi-Liang

doi:10.7499/j.issn.1008-8830.2312005

PDF(604 KB)

Chinese Journal of Contemporary Pediatrics ›› 2024, Vol. 26 ›› Issue (6) : 611-618. DOI: 10.7499/j.issn.1008-8830.2312005

CLINICAL RESEARCH

Risk factors for bronchopulmonary dysplasia in twin preterm infants: a multicenter study

FAN Yu-Wei, ZHANG Yi-Jia, WEN He-Mei, YAN Hong, SHEN Wei, DING Yue-Qin, LONG Yun-Feng, ZHANG Zhi-Gang, LI Gui-Fang, JIANG Hong, RAO Hong-Ping, QIU Jian-Wu, WEI Xian, ZHANG Ya-Yu, ZENG Ji-Bin, ZHAO Chang-Liang, XU Wei-Peng, WANG Fan, YUAN Li, YANG Xiu-Fang, LI Wei, LIN Ni-Yang, CHEN Qian, XIA Chang-Shun, ZHONG Xin-Qi, CUI Qi-Liang

Author information +

History +

Abstract

Objective To investigate the risk factors for bronchopulmonary dysplasia (BPD) in twin preterm infants with a gestational age of <34 weeks, and to provide a basis for early identification of BPD in twin preterm infants in clinical practice. Methods A retrospective analysis was performed for the twin preterm infants with a gestational age of <34 weeks who were admitted to 22 hospitals nationwide from January 2018 to December 2020. According to their conditions, they were divided into group A (both twins had BPD), group B (only one twin had BPD), and group C (neither twin had BPD). The risk factors for BPD in twin preterm infants were analyzed. Further analysis was conducted on group B to investigate the postnatal risk factors for BPD within twins. Results A total of 904 pairs of twins with a gestational age of <34 weeks were included in this study. The multivariate logistic regression analysis showed that compared with group C, birth weight discordance of >25% between the twins was an independent risk factor for BPD in one of the twins (OR=3.370, 95%CI: 1.500-7.568, P<0.05), and high gestational age at birth was a protective factor against BPD (P<0.05). The conditional logistic regression analysis of group B showed that small-for-gestational-age (SGA) birth was an independent risk factor for BPD in individual twins (OR=5.017, 95%CI: 1.040-24.190, P<0.05). Conclusions The development of BPD in twin preterm infants is associated with gestational age, birth weight discordance between the twins, and SGA birth.

Key words

Bronchopulmonary dysplasia / Risk factor / Multicenter study / Twins / Preterm infant

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

FAN Yu-Wei, ZHANG Yi-Jia, WEN He-Mei, YAN Hong, SHEN Wei, DING Yue-Qin, LONG Yun-Feng, ZHANG Zhi-Gang, LI Gui-Fang, JIANG Hong, RAO Hong-Ping, QIU Jian-Wu, WEI Xian, ZHANG Ya-Yu, ZENG Ji-Bin, ZHAO Chang-Liang, XU Wei-Peng, WANG Fan, YUAN Li, YANG Xiu-Fang, LI Wei, LIN Ni-Yang, CHEN Qian, XIA Chang-Shun, ZHONG Xin-Qi, CUI Qi-Liang. Risk factors for bronchopulmonary dysplasia in twin preterm infants: a multicenter study[J]. Chinese Journal of Contemporary Pediatrics. 2024, 26(6): 611-618 https://doi.org/10.7499/j.issn.1008-8830.2312005

References

1 Deng K, Liang J, Mu Y, et al. Preterm births in China between 2012 and 2018: an observational study of more than 9 million women[J]. Lancet Glob Health, 2021, 9(9): e1226-e1241. PMID: 34416213. PMCID: PMC8386289. DOI: 10.1016/S2214-109X(21)00298-9.
2 Isaacson A, Diseko M, Mayondi G, et al. Prevalence and outcomes of twin pregnancies in Botswana: a national birth outcomes surveillance study[J]. BMJ Open, 2021, 11(10): e047553. PMID: 34675010. PMCID: PMC8532549. DOI: 10.1136/bmjopen-2020-047553.
3 Santana DS, Silveira C, Costa ML, et al. Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO multicountry survey on maternal and newborn health[J]. BMC Pregnancy Childbirth, 2018, 18(1): 449. PMID: 30453908. PMCID: PMC6245698. DOI: 10.1186/s12884-018-2082-9.
4 李想, 富建华. 单胎与双胎早产儿的临床结局[J]. 中华新生儿科杂志（中英文）, 2023, 38(10): 637-640. DOI: 10.3760/cma.j.issn.2096-2932.2023.10.015.
5 Cheong JLY, Doyle LW. An update on pulmonary and neurodevelopmental outcomes of bronchopulmonary dysplasia[J]. Semin Perinatol, 2018, 42(7): 478-484. PMID: 30401478. DOI: 10.1053/j.semperi.2018.09.013.
6 van Katwyk S, Augustine S, Thébaud B, et al. Lifetime patient outcomes and healthcare utilization for bronchopulmonary dysplasia (BPD) and extreme preterm infants: a microsimulation study[J]. BMC Pediatr, 2020, 20(1): 136. PMID: 32213174. PMCID: PMC7093972. DOI: 10.1186/s12887-020-02037-5.
7 Shukla VV, Ambalavanan N. Recent advances in bronchopulmonary dysplasia[J]. Indian J Pediatr, 2021, 88(7): 690-695. PMID: 34018135. DOI: 10.1007/s12098-021-03766-w.
8 Yang T, Shen Q, Wang S, et al. Risk factors that affect the degree of bronchopulmonary dysplasia in very preterm infants: a 5-year retrospective study[J]. BMC Pediatr, 2022, 22(1): 200. PMID: 35413820. PMCID: PMC9004103. DOI: 10.1186/s12887-022-03273-7.
9 Sucasas Alonso A, Pértega Diaz S, Sáez Soto R, et al. Epidemiology and risk factors for bronchopulmonary dysplasia in preterm infants born at or less than 32 weeks of gestation[J]. An Pediatr (Engl Ed), 2022, 96(3): 242-251. PMID: 35256313. DOI: 10.1016/j.anpede.2021.03.006.
10 Ramos-Navarro C, Maderuelo-Rodríguez E, Concheiro-Guisán A, et al. Risk factors and bronchopulmonary dysplasia severity: data from the Spanish Bronchopulmonary Dysplasia Research Network[J]. Eur J Pediatr, 2022, 181(2): 789-799. PMID: 34596741. DOI: 10.1007/s00431-021-04248-z.
11 He W, Zhang L, Feng R, et al. Risk factors and machine learning prediction models for bronchopulmonary dysplasia severity in the Chinese population[J]. World J Pediatr, 2023, 19(6): 568-576. PMID: 36357648. PMCID: PMC10198877. DOI: 10.1007/s12519-022-00635-0.
12 Sehgal A, Gwini SM, Menahem S, et al. Preterm growth restriction and bronchopulmonary dysplasia: the vascular hypothesis and related physiology[J]. J Physiol, 2019, 597(4): 1209-1220. PMID: 29746007. PMCID: PMC6376075. DOI: 10.1113/JP276040.
13 Jobe AH, Bancalari E. Bronchopulmonary dysplasia[J]. Am J Respir Crit Care Med, 2001, 163(7): 1723-1729. PMID: 11401896. DOI: 10.1164/ajrccm.163.7.2011060.
14 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
15 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants[J]. BMC Pediatr, 2013, 13: 59. PMID: 23601190. PMCID: PMC3637477. DOI: 10.1186/1471-2431-13-59.
16 谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018.
17 Principi N, Di Pietro GM, Esposito S. Bronchopulmonary dysplasia: clinical aspects and preventive and therapeutic strategies[J]. J Transl Med, 2018, 16(1): 36. PMID: 29463286. PMCID: PMC5819643. DOI: 10.1186/s12967-018-1417-7.
18 Hwang JS, Rehan VK. Recent advances in bronchopulmonary dysplasia: pathophysiology, prevention, and treatment[J]. Lung, 2018, 196(2): 129-138. PMID: 29374791. PMCID: PMC5856637. DOI: 10.1007/s00408-018-0084-z.
19 Yu Z, Wang L, Wang Y, et al. Development and validation of a risk scoring tool for bronchopulmonary dysplasia in preterm infants based on a systematic review and meta-analysis[J]. Healthcare (Basel), 2023, 11(5): 778. PMID: 36900783. PMCID: PMC10000930. DOI: 10.3390/healthcare11050778.
20 Gilfillan M, Bhandari A, Bhandari V. Diagnosis and management of bronchopulmonary dysplasia[J]. BMJ, 2021, 375: n1974. PMID: 34670756. DOI: 10.1136/bmj.n1974.
21 Oluwole I, Tan JBC, DeSouza S, et al. The association between bronchopulmonary dysplasia grade and risks of adverse neurodevelopmental outcomes among preterm infants born at less than 30 weeks of gestation[J]. J Matern Fetal Neonatal Med, 2023, 36(1): 2167074. PMID: 36642443. DOI: 10.1080/14767058.2023.2167074.
22 D'Antonio F, Khalil A, Dias T, et al. Weight discordance and perinatal mortality in twins: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort[J]. Ultrasound Obstet Gynecol, 2013, 41(6): 643-648. PMID: 23355123. DOI: 10.1002/uog.12412.
23 Boghossian NS, Saha S, Bell EF, et al. Birth weight discordance in very low birth weight twins: mortality, morbidity, and neurodevelopment[J]. J Perinatol, 2019, 39(9): 1229-1240. PMID: 31312035. PMCID: PMC6713585. DOI: 10.1038/s41372-019-0427-5.
24 Groene SG, Spekman JA, Te Pas AB, et al. Respiratory distress syndrome and bronchopulmonary dysplasia after fetal growth restriction: lessons from a natural experiment in identical twins[J]. EClinicalMedicine, 2021, 32: 100725. PMID: 33554092. PMCID: PMC7851769. DOI: 10.1016/j.eclinm.2021.100725.
25 江苏省新生儿重症监护病房母乳质量改进临床研究协作组. 多中心回顾性分析极低及超低出生体重儿支气管肺发育不良的临床特点及高危因素[J]. 中华儿科杂志, 2019, 57(1): 33-39. PMID: 30630229. DOI: 10.3760/cma.j.issn.0578-1310.2019.01.009.
26 Gagliardi L, Rusconi F, Reichman B, et al. Neonatal outcomes of extremely preterm twins by sex pairing: an international cohort study[J]. Arch Dis Child Fetal Neonatal Ed, 2021, 106(1): 17-24. PMID: 32451356. DOI: 10.1136/archdischild-2020-318832.
27 Ambalavanan N, Nicola T, Hagood J, et al. Transforming growth factor-beta signaling mediates hypoxia-induced pulmonary arterial remodeling and inhibition of alveolar development in newborn mouse lung[J]. Am J Physiol Lung Cell Mol Physiol, 2008, 295(1): L86-L95. PMID: 18487357. PMCID: PMC2494779. DOI: 10.1152/ajplung.00534.2007.
28 Morty RE. Recent advances in the pathogenesis of BPD[J]. Semin Perinatol, 2018, 42(7): 404-412. PMID: 30384986. DOI: 10.1053/j.semperi.2018.09.001.
29 苏莎, 龙玉. 双胎生长不一致和小于胎龄儿的流行病学调查研究[J]. 现代医药卫生, 2020, 36(9): 1313-1316. DOI: 10.3969/j.issn.1009-5519.2020.09.010.
30 石碧君, 崔其亮, 谭小华, 等. 活产双胎出生体重不一致的发生情况及其与不良出生结局的关系[J]. 中华儿科杂志, 2022, 60(10): 1038-1044. PMID: 36207851. DOI: 10.3760/cma.j.cn112140-20220507-00432.
31 Amyx MM, Albert PS, Bever AM, et al. Intrauterine growth discordance across gestation and birthweight discordance in dichorionic twins[J]. Am J Obstet Gynecol, 2020, 222(2): 174.e1-174.e10. PMID: 31454510. PMCID: PMC7535857. DOI: 10.1016/j.ajog.2019.08.027.