Dysplasie broncho-pulmonaire chez les grands prématurés à Mayotte : incidence, sévérité et facteurs associés

Abstract : Introduction: advances in neonatal medicine have led to the better survival of increasingly immature preterm infants, helping to maintain a relatively high rate of bronchopulmonary dysplasia (BPD). Despite perinatal management appearing less optimal in Mayotte Island, we had the clinical impression that those African-descended preterm infants had a lower respiratory morbidity. Aims: to determine the incidence and severity of BPD in Mayotte in very preterm infants surviving at 36 weeks gestational age (GA) and to identify factors associated with the occurrence of significant BPD (moderate or severe). Material & Methods: a population-based observational study was carried out on preterm babies born between 24 and 31 weeks GA who were admitted alive in the neonatal intensive care unit of Mamoudzou between 2011 and 2015. Preterm babies were divided into five groups according to the degree of BPD: absent, mild, moderate, severe or death before 36 weeks GA. Factors associated with significant DBP (moderate or severe) were determined in multivariate analysis among survivors. Results: of the 506 preterm infants born between 24 and 32 weeks GA during the study period, 371 were eligible for analysis. Fifty (13.5%) died before 36 weeks’ post-menstrual age. The mean gestational age of survivors (n = 321) was 29.4 ± 1.7 weeks and mean birth weight was 1224 ± 316 grams. Among the survivors, the overall BPD rate was 36.8%. The incidence of mild BPD was 23.1%, moderate BPD 8.4% and severe BPD 5.3%, respectively. A significant BPD was reported in 13.7% of survivors. The composite outcome rate of children who died or who had a significant BPD was 25.3%. After logistic regression, factors independently associated with the occurrence of a significant BPD, adjusted for gestational age, were mechanical ventilation for at least 7 days (OR 11.82 [4.82 - 28.99]) and exclusive breastfeeding as a protective factor (OR 0.061 [0.008 - 0.48]). Conclusion: our study found a BPD rate among the preterm babies in Mayotte comparable to the literature. Improved perinatal management, including decreased duration of mechanical ventilation and breastfeeding promotion interventions, could reduce respiratory morbidity in this population.
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Master Thesis
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Léa Faydi. Dysplasie broncho-pulmonaire chez les grands prématurés à Mayotte : incidence, sévérité et facteurs associés. Médecine humaine et pathologie. 2017. ⟨dumas-01534593⟩

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