Risk Factors and Outcomes Associated with Pneumothorax in Very Preterm Infants.

IF 2 4区 医学 Q2 PEDIATRICS Children-Basel Pub Date : 2024-09-27 DOI:10.3390/children11101179
Cristina Nogueroles Blanco, Ana Herranz-Barbero, Mar Velilla-Aparicio, Carla Balcells-Esponera, Marta Teresa-Palacio, Miguel Alsina Casanova, Cristina Carrasco Carrasco, Cristina Borràs-Novell, José Manuel Rodríguez-Miguélez, Ma Dolors Salvia-Roigés, Victoria Aldecoa-Bilbao
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Abstract

Background/objectives: Pneumothorax can be a major complication of neonatal lung diseases. We aim to delineate trends and describe the main outcomes related to pneumothorax in very preterm infants (VPI).

Methods: Preterm infants < 32 weeks of gestation admitted in two-level III neonatal intensive care units (1995-2019) were included. Risk factors and outcomes were assessed by logistic regression and adjusted for gestational age (GA).

Results: In total, 4271 VPI with a mean GA of 28.7 ± 2.3 weeks were evaluated. Pneumothorax was diagnosed in 174 patients (4.1%, 95% Confidence Interval (CI) 3.5-4.7) with its incidence inversely proportional to GA: 9.9% in 23-25 w and 2.1% in 30-31 w (p < 0.001), but stable over the years 1995-1999 (5.2%) and 2015-2019 (4.2%) (p = 0.309). Patients with pneumothorax exhibited higher rates of severe intraventricular hemorrhage (IVH) (Odds Ratio (OR) = 2.0 (95%CI 1.3-3.1), p = 0.003), bronchopulmonary dysplasia (OR = 2.7 (95%CI 1.7-4.4), p < 0.001), and death (OR = 8.5 (95%CI 6.2-11.6), p < 0.001). Independent risk factors for pneumothorax were GA, prolonged premature rupture of membranes, and intubation in the delivery room. The composite outcome of death or severe IVH was higher in patients with pneumothorax with an adjusted OR = 6.7 (95%CI 4.7-9.6), p < 0.001. Although VPI mortality has significantly decreased over the years (20.3% 1995-1999 and 11.7% 2015-2019, p < 0.001), we found no significant difference in pneumothorax-related deaths.

Conclusion: Pneumothorax remains a serious threat to VPI, leading to a higher incidence of morbidity, and mortality attributable to this complication has not decreased. Preventive strategies and early recognition are essential for improving disability-free survival in VPI.

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早产儿气胸的相关风险因素和结果
背景/目的:气胸是新生儿肺部疾病的主要并发症。我们旨在描述早产儿(VPI)中与气胸相关的趋势和主要结果:方法:纳入在两家三级新生儿重症监护病房(1995-2019 年)住院的妊娠期小于 32 周的早产儿。通过逻辑回归评估风险因素和结果,并根据胎龄(GA)进行调整:共评估了 4271 例 VPI,平均胎龄(28.7 ± 2.3 周)。174名患者(4.1%,95% 置信区间(CI)3.5-4.7)被诊断为气胸,其发生率与胎龄成反比:23-25周为9.9%,30-31周为2.1%(p < 0.001),但在1995-1999年(5.2%)和2015-2019年(4.2%)期间保持稳定(p = 0.309)。气胸患者发生严重脑室内出血(IVH)(Odds Ratio (OR) = 2.0 (95%CI 1.3-3.1),p = 0.003)、支气管肺发育不良(OR = 2.7 (95%CI 1.7-4.4),p < 0.001)和死亡(OR = 8.5 (95%CI 6.2-11.6),p < 0.001)的比例较高。气胸的独立风险因素是GA、胎膜早破时间过长和产房插管。气胸患者的死亡或严重 IVH 的综合结果较高,调整后 OR = 6.7 (95%CI 4.7-9.6),P < 0.001。虽然VPI死亡率逐年大幅下降(1995-1999年为20.3%,2015-2019年为11.7%,p < 0.001),但我们发现气胸相关死亡并无显著差异:气胸仍然是对 VPI 的严重威胁,会导致更高的发病率,而且这种并发症导致的死亡率并未降低。预防策略和早期识别对于提高 VPI 的无残疾存活率至关重要。
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来源期刊
Children-Basel
Children-Basel PEDIATRICS-
CiteScore
2.70
自引率
16.70%
发文量
1735
审稿时长
6 weeks
期刊介绍: Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries. The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.
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