国外医学动态｜中国早产儿支气管肺发育不良点患病率、特征及治疗差异：一项“快照式”研究中华医学会围产医学分会

早产儿支气管肺发育不良（bronchopulmonary dysplasia，BPD）的患病率呈上升趋势，而目前中国BPD患病率及诊疗差异现况的研究数据仍然不足。2024年10月发表在BMJ paediatrics open的一项来自中国的研究[1]，针对某一时点我国BPD的点患病率及诊疗差异情况进行了调查（即“快照式”研究）。

该研究是一项多中心横断面研究，涵盖国内6个地区37个新生儿重症监护病房的1 044例早产儿。收集2021年6月18日当日新生儿重症监护病房住院的出生胎龄小于32周的早产儿临床数据。BPD诊断参照以下3个标准，美国国家儿童健康与人类发展研究所（NICHD）2001年、2018年标准和Jensen 2019年标准。NICHD 2001的BPD诊断标准为出生胎龄<32周且生后≥28天仍需持续供氧。在矫正胎龄36周时，根据呼吸支持和吸氧情况来确定BPD的严重程度。主要研究结局为有BPD患病风险早产儿（定义为出生胎龄小于32周且生后日龄≥28天或矫正胎龄≥36周）研究日当天BPD的点患病率。

研究共纳入1 044例出生胎龄小于32周的早产儿，其中72%患儿出生胎龄≥28周，95.8%出生体重≥750 g。数据采集当日，563例婴儿≥28日龄，281例矫正胎龄≥36周，BPD的点患病率为78.2%（NICHD 2001年标准）。研究发现，患有BPD的早产儿与出生胎龄小，出生体重低有关，且多伴有并发症。达到矫正胎龄36周的早产儿，根据不同诊断标准，BPD点患病率和严重程度分级均不同。对于诊疗情况的调查显示，各新生儿重症监护室采取的呼吸支持和BPD治疗也存在显著差异。

该研究表明，我国早产儿BPD的点患病率非常高，且BPD患儿并发症更多。采用不同的诊断标准使得BPD患病率和严重程度分级存在差异，根据NICHD 2018年的定义，BPD点患病率最低，而NICHD 2001的定义将大多数患者归类为重度BPD。不同医院的BPD治疗也存在显著差异。因此，开展更多早产儿BPD的相关研究，制定针对我国的早产儿BPD预防和规范诊疗标准，对于提高我国早产儿BPD的诊疗水平改善早产儿预后的是十分必要的。

原文摘要

Point prevalence, characteristics and treatment variations for preterm infants with bronchopulmonary dysplasia in China: a 'snapshot' study

Objective: The incidence of bronchopulmonary dysplasia (BPD) is increasing, but data on its prevalence and management variations remain insufficient in China. The study aims to investigate its point prevalence and variations in BPD care.

Setting, patients and interventions: A multicentre cross-sectional study was conducted in 37 NICUs. 'Snapshot' clinical data on 18 June 2021 for individual patients born at <32 weeks gestation age (GA) were collected. BPD was defined based on the National Institute of Child Health and Human Development (NICHD) 2001 criteria and two newer criteria (NICHD 2018 and Jensen 2019).

Results: A total of 1044 infants born at <32 weeks GA were included, of which 72% were born at ≥28 weeks GA and 95.8% were born at ≥750 g. At the time of 'snapshot', 563 were ≥28 days old and 281 were ≥36 weeks postmenstrual age (PMA). The prevalence of BPD was 78.2% per NICHD 2001 definition. Infants with BPD were more likely to be born earlier with a lower birth weight and to have complications. Among infants who reached 36 weeks PMA, the point prevalence and severity of BPD differed across BPD definitions. Respiratory support and treatments for BPD also significantly varied.

Conclusion: Point prevalence of BPD is remarkably high in China. The prevalence of BPD was lowest according to the NICHD 2018 definition, whereas the NICHD 2001 definition classified most patients with severe BPD. We found infants with BPD have more complications and significant differences in BPD treatments between centres. Efforts to prevent BPD and standardise care are warranted in China.