Buse OZER BEKMEZ, Mehmet BÜYÜKTİRYAKİ, Fatma Nur SARI, Evrim ALYAMAC DİZDAR, Cüneyt TAYMAN, Suna OGUZ

Orta-Ağır Bronkopulmoner Displazide Tek Merkez Deneyimi: Antenatal ve Postnatal Risk Faktörleri

Amaç: Bronkopulmoner displazi (BPD), çok düşük doğum ağırlıklı her üç bebekten birini etkileyen uzun dönem ciddi olumsuz sonuçları olan bir prematüre morbiditesidir. Bu çalışmada orta-ağır BPD için antenatal ve postnatal risk faktörlerini araştırmayı amaçladık. Gereç ve Yöntemler: Tek merkezli retrospektif kohort çalışmada Ocak 2014-Aralık 2018 tarihleri arasında doğan <32 hafta ve <1500 g bebekler dahil edildi. Orta-ağır BPD tanılı hastalar çalışma grubunu, hafif BPD ve BPD tanısı olmayan hastalar kontrol grubunu oluşturdu. Her iki grup antenatal ve postnatal özellikleri açısından karşılaştırıldı. Bulgular: 626 bebekten oluşan kohortun ortalama gestasyonel yaş ve doğum ağırlığı sırasıyla 28±1.4 hafta ve 1084±225 g’dı. Orta-ağır BPD tanılı 97 bebeğin (%15.4) ortalama gestasyonel yaş ve doğum ağırlıkları, kontrol grubuna göre anlamlı olarak düşük saptandı (27±1.5 ve 28.3±1.7 hafta; 933±201 ve 1108±256 g sırasıyla; p<0.001). Doğum salonunda ileri canlandırma (OR 2.64, Cl [1.57-4.4]), gestasyonel yaş (OR 0.80 Cl [0.67-0.95]), hemodinamik anlamlı patent duktus arteriozus (haPDA) (OR 1.78 Cl [1.05-3.03]) ve geç tam enteral beslenme (OR 1.05 Cl [1.02-1.08]) orta/ağır BPD ile ilişkili bulundu. Sonuç: Doğum salonunda ileri canlandırma, düşük gestasyon haftası, haPDA ve geç tam enteral beslenme BPD ile ilişkili bulunmuştur. Ancak tam enteral beslenmeye geçiş süresi ve haPDA ile BPD ilişkisinin neden sonuç mu, yoksa BPD’ye gidiş sürecindeki hastalık durumunun bir parçası olup olmadığının ortaya çıkarılması için geniş çaplı prospektif çalışmalara ihtiyaç olduğu düşünülmüştür.

Anahtar Kelimeler:

bronkopulmoner displazi, prematürite, enteral beslenme

Antenatal and Postnatal Risk Factors for Bronchopulmonary dysplasia: Single-center Experience

Objective: Bronchopulmonary dysplasia (BPD) is the chronic lung disease of prematurity that affects a substantial proportion of extremely preterm infants. We aimed to find out the antenatal and postnatal risk factors for BPD in a large-scale cohort of preterm infants. Material and Methods: Records of preterm infants born <32 gestational weeks and <1500 g were included in this single-center retrospective study that was performed between January 2014 and December 2018. While babies with moderate and severe BPD constituted the study group, the control group included those with mild BPD and without BPD. Groups were compared in terms of antenatal and postnatal risk factors. Results: In the final analysis, data of 626 infants were recorded. The mean gestational age and birth weight of the whole cohort were 28±1.4 weeks and 1084±225 g, respectively. Ninety-seven (15.4%) infants in the study group had significantly lower gestational age and birth weight compared to those in the control group (27±1.5 vs 28.3±1.7 weeks, and 933±201 vs 1108±256 g respectively, p<0.05). Extensive resuscitation in the delivery room (OR 2.64, Cl [1.57-4.4]), low gestational age (OR 0.80 Cl [0.67-0.95]), hemodynamically significant patent ductus arteriosus (hsPDA) (OR 1.78 Cl [1.05-3.03]) and delayed full enteral feeding (OR 1.05 Cl [1.02-1.08]) were associated with a higher rate of moderate-to-severe BPD. Conclusion: Large-scale randomized controlled trials are warranted to elucidate whether the association of hsPDA and delayed full enteral feeding with BPD is a real cause and effect relationship or a component of illness state during the process of evolving BPD.

Keywords:

Bronchopulmonary dysplasia, Enteral nutrition, Prematurity,

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