极低和超低出生体重儿重度脑室内出血发生情况及其影响因素多中心研究  

Incidence and risk factors of severe intraventricular hemorrhage in very low and extremely low birth weight infants: a multi-center study

作　　者：中国新生儿重症监护室协作性质量改进研究协作组 曹云 Reduction of Infection in Chinese Neonatal Intensive Care Units Using the Evidence-based Practice for Improving Quality Study Group;Cao Yun(Department of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China)

机构地区：[1]不详 [2]复旦大学附属儿科医院新生儿科,上海201102

出　　处：《中华儿科杂志》2019年第4期258-264,共7页Chinese Journal of Pediatrics

基　　金：美国中华医学基金会资助项目(14-194);2016年上海市卫生计生系统重要薄弱学科建设计划项目(儿科学)(2016ZB0101).

摘　　要：目的分析极低和超低出生体重儿重度脑室内出血(IVH)的发生情况及其影响因素。方法数据来源于"基于循证实践的质量改进方法降低中国新生儿重症监护病房感染发生率的整群随机对照试验"所建立的早产儿临床数据库,前瞻性采集中国25家三级新生儿重症监护病房2015年5月至2018年4月收治的出生胎龄<34周、生后7 d内入院患儿的临床资料。通过标准数据库采集临床数据,进行二次分析,研究对象为原始数据库中住院期间完成头颅影像学检查的极低和超低出生体重儿,排除先天畸形,共纳入8 835例患儿,男性占52.6%(4 643例)。采用描述性统计分析极低和超低出生体重儿重度IVH的发生情况。将患儿分为重度IVH组和未发生或轻度IVH组,采用单因素t检验、χ2检验和多因素Logistic多元回归分析方法进行组间比较和分析重度IVH发生的影响因素。结果8 835例患儿中,重度IVH的发生率是7.4%(650例);超低出生体重儿和出生胎龄≤28周早产儿重度IVH的发生率分别是13.5%(160/1 185)和13.1%(368/2 800)。出生体重<750 g、750~999 g、1 000~1 249 g、1 250~1 499 g的早产儿重度IVH的发生率分别为21.1%(31/147)、12.4%(129/1 038)、8.3%(246/2 966)、5.2%(244/4 684);出生胎龄<26周、26~28+6周、29~31+6周、32~33+6周的早产儿重度IVH的发生率分别为25.2%(55/218)、12.1%(313/2 582)、5.2%(243/4 649)、2.8%(39/1 386)。经Logistic多元回归分析,重度IVH的独立保护因素是出生胎龄(OR=0.752,95%CI:0.687~0.823,P=0.000)和剖宫产出生(OR=0.733,95%CI:0.592~0.907,P=0.004);独立危险因素是5 min Apgar评分≤3分(OR=1.897,95%CI:1.194~3.013,P=0.007),生后第1周内使用有创机械通气(OR=1.499,95%CI:1.207~1.862,P=0.000),生后第1周内使用血管活性药物(OR=2.093,95%CI:1.724~2.541,P=0.000)。结论极低和超低出生体重儿重度IVH的发病率仍较高,小胎龄、非剖宫产、5 min Apgar评分≤3分、生后第1周内使用有创机械通气、生�Objective To investigate the incidence and risk factors of severe intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI). Methods The data were from "reduction of infection in Chinese neonatal intensive care units using the evidence-based practice for improving quality"study, which prospectively enrolled infants with gestational age less than 34 weeks, and were admitted within the first seven days of life in 25 tertiary neonatal intensive care units from May 2015 to April 2018. Clinical data of VLBWI and ELBWI, who had neuroimage examination during the hospitalization, were retrospectively extracted from the standard database and were secondarily-analyzed. Patients with congenital malformations were excluded. A total of 8 835 VLBWI and ELBWI were enrolled with 52.6%(4 643 cases) male, who were divided into severe IVH group and without IVH or mild IVH group. Descriptive statistics were used to analyze the incidence of severe IVH. Comparison between two groups and risk factors were analyzed with univariate and multivariate Logistic regression analysis. Results The incidence of severe IVH in the 8 835 infants was 7.4%(650/8 835). And the incidences of severe IVH in ELBWI and preterm infants with gestational age ≤28 weeks were 13.5%(160/1 185) and 13.1%(368/2 800), respectively. The incidences of severe IVH in preterm infants with birth weight<750 g, 750-999 g, 1 000-1 249 g, 1 250-1 499 g were 21.1%(31/147), 12.4%(129/1 038), 8.3%(246/2 966) and 5.2%(244/4 684), respectively;and were 25.2%(55/218), 12.1%(313/2 582), 5.2%(243/4 649) and 2.8%(39/1 386) in the preterm infants with gestational age<26 weeks, 26-28+6 weeks, 29-31+6 weeks, 32-33+6 weeks, respectively. Logistic regression analysis revealed that gestation age (OR=0.752, 95%CI: 0.687-0.823, P=0.000) and cesarean delivery (OR=0.733, 95%CI: 0.592-0.907, P=0.004) decreased the risks of severe IVH;while Apgar score ≤3 at 5 minutes (OR=1.897, 95%CI: 1.194-3.013, P=0.007), use of invasive mechan

关 键 词：婴儿 极低出生体重 婴儿 超低出生体重 脑室内出血 影响因素 

分 类 号：R722.6[医药卫生—儿科]