태아의 성장지연의 정도가 기관지폐이형성증 및 사망에 미치는 영향
The extent of fetal growth restriction and bronchopulmonary dysplasia or mortality in premature infants
Abstract
Purpose: The objective of this study was to assess whether the extent of fetal growth restriction is associated with bronchopulmonary dysplasia (BPD) or death in preterm infants. Methods: Using data from the Korean Neonatal Network, we investigated 5,003 premature infants who were born at less than 32 weeks of gestation and birth weight (BW) less than 1,500 g. Body measurements at birth were adjusted for gestational age (GA) and sex with reference to the Fenton 2013 growth curve. Associations between body measurements, prenatal factors, and risk of BPD or deaths were evaluated in univariate analyses. Subsequent multivariate logistic regression with backward elimination was performed. Results: A total of 4995 preterm infants were enrolled, and 690 infants died before 36 weeks’ postmenstrual age. GA, BW, BW z-score, height (HT) and HT z-score at birth, head circumference and head circumference z-score at birth, gender, oligohydramnios were significantly associated with BPD or deaths in univariates analysis. In multivariate regression analysis, BW (odds ratio (OR) = 1.17, 95% Confidence interval (CI) = 1.03, 1.31 at GA 23-25 weeks; OR = 1.17, 95% CI = 1.12, 1.24 at GA 26-28 weeks), HT z-score at birth (OR = 1.32, 95% CI = 1.06, 1.63 at GA 23-25 weeks; OR = 1.16, 95% CI = 1.03, 1.32 at GA 26-28 weeks), female (OR = 0.47, 95% CI = 0.32, 0.68 at GA 23-25 weeks; OR = 0.59, 95% CI = 0.47, 0.73 at GA 26-28 weeks) were significantly correlated with BPD or deaths. Regarding to the extent of fetal growth restriction, only HT z-score was significantly correlated with BPD or death. In preterm infant who were born at more than 28 weeks of GA, BW and gender were significantly associated with BPD or death. Conclusion: The extent of fetal height growth restriction had a significant correlation with BPD or death after adjusting other known prenatal risk factors of BPD in premature infants under GA 28 weeks. HT z-score at birth can be an important predictor of BPD risk or mortality. Fetal somatic growth, especially height growth, may have a significant impact on lung development and mortality.