Influence of various factors on the formation of outcomes of bronchopulmonary dysplasia in children

Background. Today, bronchopulmonary dysplasia (BPD) is an important problem in modern pediatrics. Severe chronic lung pathology is often formed in children after BPD. It is known that the main predictors of BPD severity are gestational age, respiratory distress syndrome, duration of mechanical ventilation (MV) modes, and comorbidities. At the same time, various variants of the course and outcomes of BPD are diagnosed in a number of premature infants, despite identical nursing conditions and respiratory support modes, which dictates the need for further evaluation of pathogenetic mechanisms. Objective. Identification of the main factors determining the outcomes of BPD in children. Methods. The study involved 146 patients (main group) with a previously established BPD diagnosis at the age from 2 years 11 months to 4 years 1 month (3.35±0.13 years). The gestational age in children of the main group ranged from 25 to 37 weeks (30.9±2.3 weeks), weight at birth - from 562 to 2500 g (1458±458 g). Depending on the variant of the transformation of the diagnosis, the patients were divided into 2 subgroups: the first was formed by 88 children (3.7±0.43 years), in whom the restoration of morphofunctional structures with implementation in the form of recovery or recurrent bronchitis was observed; the second subgroup consisted of 58 patients (3.2±0.66 years) with unfavorable outcomes of the disease in the form of chronic bronchitis or obliterating broncholitis. Results. The results of this study indicate that chronic lung diseases are significantly more likely to develop in patients with severe BPD, while favorable outcomes of the disease were more often observed in patients with moderate BPD. Statistical analysis showed that in children born at a gestational age of less than 31 weeks, the outcome in the form of chronic bronchitis and obliterating bronchiolitis was significantly more frequent. Analysis of the duration and modes of ventilation support showed that mechanical ventilation with strict parameters immediately after childbirth and the duration of respiratory support more than 3 weeks were among the main risk factors for the formation of BPD outcomes in the form of chronic lung diseases. The study revealed that concomitant laryngostenosis was a predisposing factor for the formation of BPD outcomes in the form of chronic lung diseases. According to our data, early (age up to one year) starts and a high frequency of respiratory viral infections in children with BPD are a predisposing factor for an unfavorable outcome of BPD in the form of chronic bronchitis, obliterating bronchiolitis, and pneumofibrosis. Conclusion. Thus, it can be argued that the formation of chronic lung diseases as option of the BPD outcome is associated with a variant of the course of the disease, gestational age, duration and parameters of mechanical ventilation, the presence of concomitant pathology, high frequency and early start of ARVI.

bronchopulmonary dysplasia, gestational age, mechanical ventilation