ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Neonatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1629279
Predictors of Bronchopulmonary Dysplasia Occurrence and Severity in Extremely Preterm Infants
Provisionally accepted
- 1Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
- 2Nankai University Affiliated Maternity Hospital, Tianjin, China
- 3Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, China
- 4Tianjin Central Hospital for Gynecology and Obstetrics, Tianjin, China
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Background: Bronchopulmonary dysplasia (BPD) is a common complication in extremely preterm infants (EPIs), and there is currently a lack of effective preventive strategies. Identifying risk factors may facilitate early interventions and improve outcomes. Objective: To investigate risk factors for the occurrence and severity of BPD in EPIs and inform potential prevention strategies. Methods: We conducted a retrospective analysis of medical records from EPIs admitted to the neonatal intensive care unit at Tianjin Central Hospital of Obstetrics and Gynecology between 2012 and 2024. BPD was diagnosed according to the 2018 revised criteria established by the National Institute of Child Health and Human Development. Multivariable logistic regression was used to identify independent risk factors.Results: Among 468 EPIs, 136 (29.1%) developed BPD (mild: 14.1%, moderate: 7.1%, severe: 7.9%).Independent risk factors for BPD included prolonged invasive mechanical ventilation (IMV, OR = 1.10, 95% CI 1.03-1.17), frequent red blood cell transfusions (RBCTs, OR = 1.61, 95% CI 1.30-2.01), extended antibiotic exposure (OR = 1.03, 95% CI 1.01-1.06), and hemodynamically significant patent ductus arteriosus (hsPDA, OR = 2.27, 95% CI 1.22-4.20). Prolonged IMV (OR = 1.16, 95% CI 1.06-1.27) and higher fluid balance (FB) on postnatal day 7 (OR = 1.19, 95% CI 1.05-1.34) were independent risk factors for moderate-to-severe BPD, while higher birth weight (OR = 0.99, 95% CI 0.988-0.998) was found to be a protective factor. Whole blood transfusion was associated with an increased risk of BPD (OR = 4.48, 95% CI 1.92-10.43) and moderate-to-severe BPD (OR = 4.81, 95% CI 1.24-18.63) compared to packed RBCTs. In predicting moderate-to-severe BPD, the duration of IMV (cut-off: 6.5 days) and FB on postnatal day 7 (cut-off: -7.2) demonstrated significant predictive value. Conclusions:In conclusion, the occurrence and severity of BPD in EPIs are influenced by prolonged IMV, frequent RBCTs, fluid overload, excessive antibiotic exposure, and hsPDA. Early interventions targeting modifiable factors, such as reducing IMV duration, maintaining an appropriate negative FB on postnatal day 7, and optimizing transfusion protocols, are critical to prevent moderate-to-severe BPD.
Keywords: extremely premature infants, Bronchopulmonary Dysplasia, Invasive mechanical ventilation, transfusion, Fluid balance, antibiotics, patent ductus arteriosus
Received: 15 May 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Liu, Zhang and Ding. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fangrui Ding, Tianjin Central Hospital for Gynecology and Obstetrics, Tianjin, China
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