双胎新生儿出生体重不一致对其之一并发症发生风险影响  

Birthweight discordance of twin newborns on their risk of complications

作　　者：杨玲[1] 王贝贝[2] 周燕 宿静 顾宁[1] 卜蓓蓓 戴毅敏[1] Yang Ling;Wang Beibei;Zhou Yan;Su Jing;Gu Ning;Bu Beibei;Dai Yimin(Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu Province,China;Neonatal Medical Center,Children′s Hospital Affiliated to Nanjing Medical University,Nanjing 210008,Jiangsu Province,China)

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,210008 [2]南京医科大学附属儿童医院新生儿医疗中心,210008

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第1期102-110,共9页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：江苏省产科临床医学中心(创新平台)建设单位(苏卫科教[2016]17号)。

摘　　要：目的探讨双胎新生儿出生体重差值(ΔBW)预测双胎新生儿之一发生并发症的临床意义。方法选择2018年1月至2019年12月,在南京大学医学院附属鼓楼医院分娩的752对(1504例)活产双胎新生儿,及其母亲为研究对象。根据双胎新生儿是否发生并发症(双胎新生儿之一或双胎新生儿均发生并发症),将其分别纳入研究组(n=178)和对照组(n=574);再根据研究组双胎新生儿是否被转入新生儿重症监护病房(NICU),进一步分为NICU亚组(n=153)和非NICU亚组(n=25)。影响双胎新生儿之一发生并发症因素进行单因素分析和多因素非条件logistics回归分析,并绘制预测双胎新生儿之一总体并发症的受试者工作特征(ROC)曲线。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求,并经南京大学医学院附属鼓楼医院伦理委员会审核批准(批准文号:2020-264)。结果①752对双胎中,178对双胎新生儿之一发生并发症,发生率为23.7%(178/752)。②研究组双胎的剖宫产术分娩率、辅助生殖率、出生胎龄与体重及Apgar评分均低于对照组,而研究组产妇妊娠期高血压疾病(HDCP)、单绒毛膜(MC)双胎妊娠、双胎之一出生体重<P10或<P3所占比例、ΔBW及转入NICU率,均显著高于对照组,并且差异均有统计学意义(P<0.05)。③NICU亚组双胎出生胎龄及体重、生后1和5 min Apgar评分,均低于非NICU亚组,并且差异均有统计学意义(P<0.05)。④多因素非条件logistics回归分析结果显示,剖宫产分娩(OR=0.246,95%CI:0.145~0.418,P<0.001)、胎龄<37周(OR=22.294,95%CI:10.884~45.666,P<0.001),双胎之一脐血流异常(OR=2.879,95%CI:1.183~7.004,P=0.020),双胎之一出生体重<P3(OR=3.384,95%CI:1.598~7.164,P=0.001),均是双胎新生儿之一发生并发症的独立影响因素。对ΔBW分层分析结果显示,20%≤ΔBW<30%(OR=4.799,95%CI:2.612~8.814,P<0.001)与ΔBW≥30%(OR=15.984,95%CI:4.369~58.475,P<0.001),亦是双胎新生儿之一�Objective To explore clinical significance of birthweight discordance of twin newborns(ΔBW)in predicting their complications.Methods From January 2018 to December 2019,a retrospective study was conducted on 752 pairs of twins(1504 cases)who delivered in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,and among them one of the twins not transferred to neonatal intensive care unit(NICU)for at least one case.According to whether one of twin newborns had complications,they were divided into study group(n=178)and control group(n=574).According to whether one of twins in study group was transferred to NICU,it was further divided into NICU subgroup(n=153)and non-NICU subgroup(n=25).Methods of single-factor analysis and multi-factor unconditional logistics regression analysis were performed on risk factors of twin newborn complications,and receiver operating characteristic(ROC)curve for predicting the total risk factors of twin newborn complications was drawn.The procedure followed in this study met the requirements of the Helsinki Declaration of the World Medical Association revised in 2013,and had been reviewed and approved by the Ethics Committee of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School(Approval No.2020-264).Results①Among 752 pairs of twins,one of 178 pairs of twins had complications,the incidence rate was 23.7%(178/752).②The cesarean section rate,assisted reproduction rate,gestational age,birth weight and Apgar score of twins in study group were lower than those in control group,while the proportion of pregnancy-induced hypertension,monochorionic(MC)twin pregnancies and birth weight of one twin<P10 or<P3,ΔBW and rate of transfer to NICU in study group were significantly higher than those in control group,and the differences between two groups were statistically significant(P<0.05).③The gestational age,birth weight,Apgar score of twins in NICU subgroup were lower than those in non-NICU subgroup,and the differences were

关 键 词：出生体重 双胎 出生体重差值 新生儿预后 新生儿并发症 双胎妊娠 

分 类 号：R47[医药卫生—护理学]