极低出生体重儿NEC的高危因素及母乳喂养质量改进的效果评价  

Analysis of high risk factors of necrotizing enterocolitis in very low birth weight infants and the effect of breastfeeding

作　　者：陈倩 龚小慧[1] 裘刚[1] 蔡成[1] 陈豪 CHEN Qian;GONG Xiaohui;QIU Gang;CAI Cheng;CHEN Hao(Neonatal Department,Shanghai Children’s Hospital,Shanghai Jiaotong University,Shanghai 200062,China)

机构地区：[1]上海交通大学附属儿童医院(上海市儿童医院)新生儿科,上海200062

出　　处：《中国优生与遗传杂志》2021年第2期186-189,共4页Chinese Journal of Birth Health & Heredity

摘　　要：目的评价加强母乳喂养在降低新生儿重症监护病房(NICU)极低出生体重儿(VLBWI)坏死性小肠结肠炎(necrotizingenterocolitis,NEC)发生率的效果,分析VLBWINEC发生的影响因素如危险因素或保护因素。方法通过强化母乳喂养的方式,对前后两年在NICU住院的VLBWI进行持续质量改进管理。研究组为2016年1-12月医院NICU实施质量改进措施后收治的VLBWI,对照组为2015年1-12月NICU实施质量改进措施前收治的VLBWI,采用病例报告表的方式收集临床资料。对两组VLBWI的临床资料进行分析、总结,采用Logistic回归分析归纳NEC发生的影响因素。结果NEC的发生率与母乳喂养、母亲妊娠期并发症[肝内胆汁淤积(intrahepatic cholestasis of pregnancy,ICP)、其他]、败血症、肺炎、肺炎合并休克、有血流动力学改变的动脉导管未闭(hemodynamic significant patent ductus arteriosus,hs PDA)、脐静脉置管(umbilical vein catheter,UVC)、出院时体重增长幅度等多种因素相关。对这些因素进行Logistic回归分析,结果显示:母乳喂养(OR=0.206,P=0.030)为极低出生体重儿NEC发生的保护因素,败血症(OR=6.222,P=0.013)是极低出生体重儿NEC发生的危险因素。结论加强母乳喂养降低VLBWINEC的发生具有良好效果。母乳喂养为VLBWINEC发生的保护因素,败血症为VLBWI NEC发生的危险因素。积极提倡VLBWI母乳喂养,推动母乳库的建立,以降低其NEC发病率。Objective To evaluate the effect of the quality-improving program on reducing the incidence of necrotizing enterocolitis(NEC)of very low birth weight infants in neonatal intensive care units(NICU).The program is enhancing breastfeeding.To analyze the risk or protective factors for development of NEC in very low birth weight infants and to testify that breastfeeding is the protective factor for development of NEC,for promoting breastfeeding.Methods Through enhancing breastfeeding,continuous quality improvement management was carried out for the very low birth weight children who had been hospitalized in NICU for the two years.From January 2016 to December 2016,the very low birth weight infants admitted to NICU in Children’s Hospital Jiao tong University after the implementation of quality improvement program were assigned into the observative group,and the infants admitted from January 2015 to December 2015 without the program were in the control group.The clinical data were collected using case report forms and were analyzed and summarized,and the relevant factors for development of NEC were analyzed by Logistic regression test.Results The study has shown that the incidence of NEC is relevant to multiple factors,which were include of breastfeeding,pregnancy complications(intrahepatic cholestasis of pregnancy(ICP),other),sepsis,pneumonia,combined with pneumonia and shock,hemodynamic significant patent ductus arteriosus(hs PDA),Umbilical Venous Catheters(UVC)and weight growth at discharge.Logistic regression analysis is performed on these factors.The results reveals breastfeeding(OR=0.206,P=0.030)is the protective factor for development of NEC in very low birth weight infants whereas sepsis(OR=6.222,P=0.013)is the risk factor for development of NEC in very low birth weight infants.Conclusion Strengthening breastfeeding has a positive effect on reducing the incidence of NEC of very low birth weight infants.Breastfeeding is the protective factor for development of NEC in very low birth weight infants,whereas sepsis

关 键 词：母乳喂养 坏死性小肠结肠炎 保护因素 危险因素 极低出生体重儿 

分 类 号：R722.6[医药卫生—儿科]