Platelet is the early predictor of bronchopulmonary dysplasia in very premature infants: an observational cohort study

Abstract Background: A previous study showed that the lungs are involved in the biogenesis of platelets (PLTs). Thus, the present study aimed to investigate the association between bronchopulmonary dysplasia (BPD), a chronic lung disease, and PLT parameters in very premature infants.Methods: The study subjects were premature infants with a gestational age of ≤ 30 weeks and birth weight of ≤1500 g in a preterm birth cohort study recruited between January 1, 2015, and August 31, 2019. BPD was defined as the need for oxygen supplementation more than 28 days after birth. The PLT count, mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) level were compared between BPD and non-BPD infants. A generalized estimating equation model was used to adjust for confounding factors. A forward stepwise logistic regression model was used to calculate the adjusted odds ratio (OR) for thrombocytopenia in the BPD group. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of PLT count combined with gestational age (GA) and birth weight (BW) for BPD.Results: The final study subjects were 134 very premature infants, namely, 64 infants with BPD and 70 infants without BPD. The BPD infants had lower PLT counts (F=4.44, P=0.03) and PCT levels (F=12.54, P=0.00) than the non-BPD infants. However, the MPV (F=14.25, P=0.00) and PDW (F=15.04, P=0.00) were higher in the BPD group. After adjusting for potential confounding factors, the BPD infants had a higher risk of thrombocytopenia than the non-BPD infants (adjusted aOR 2.88, 95% CI 1.01-8.15), and the risk of BPD was increased in very premature infants with a PLT count ≤ 177*109/L (OR 4.74, 95% CI 1.93-11.62) at the end of the second week. In the multivariate predictive model, it was showed that the AUC area (0.85), sensitivity (0.88), specificity (0.70) and Youden index (0.58) are improved using PLT counts ≤ 177*109/L combined with GA and BW.Conclusions: Abnormal PLT parameters were observed in BPD infants, and a PLT count ≤ 177*109/L was a potential risk factor for the development of BPD in very premature infants.