出生胎龄<34周住院早产儿出院预后分析  

Outcomes at discharge of preterm infants born<34 weeks′gestation

作　　者：骆凝馨 蒋思远 曹云 李淑涓 韩俊彦[2] 周琦 李萌萌[3] 郭金珍 刘红艳[5] 杨祖铭[6] 冀湧[7] 张宝泉[8] 黄智峰[9] 袁静 潘丹丹 石静云[12] 胡雪峰[13] 林素[14] 赵倩[15] 晏长红[16] 王乐[17] 韦秋芬[18] 阚清[19] 高金枝[20] 刘翠青[21] 姜善雨[22] 刘向红[23] 孙慧清[24] 杜娟[25] 何利[26] 中国新生儿重症监护室协作性质量改进研究协作组 Luo Ningxin;Jiang Siyuan;Cao Yun;Li Shujuan;Han Junyan;Zhou Qi;Li Mengmeng;Guo Jinzhen;Liu Hongyan;Yang Zuming;Ji Yong;Zhang Baoquan;Huang Zhifeng;Yuan Jing;Pan Dandan;Shi Jingyun;Hu Xuefeng;Lin Su;Zhao Qian;Yan Changhong;Wang Le;Wei Qiufen;Kan Qing;Gao Jinzhi;Liu Cuiqing;Jiang Shanyu;Liu Xianghong;Sun Huiqing;Du Juan;He Li;Reduction of Infection in Chinese Neonatal Intensive Care Units Using the Evidence-based Practice for Improving Quality(Department of Neonatology,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China;National Health Commission(NHC)Key Laboratory of Neonatal Diseases,Children′s Hospital of Fudan University,National Children's Medical Center,Shanghai 201102,China;Department of Neonatology,Women's Hospital of Nanjing Medical University,Nanjing 210004,China;Department of Neonatology,Northwest Women′s and Children′s Hospital,Xi′an 200001,China;Department of Neonatology,Maternal and Child Hospital of Hubei Province,Wuhan 430064,China;Department of Neonatology,Suzhou Municipal Hospital,Suzhou 215008,China;Department of Neonatology,Shanxi Children′s Hospital,Taiyuan 030006,China;Department of Neonatology,Fujian Maternity and Child Health Hospital,Fuzhou 350005,China;Department of Neonatology,the Affiliated Shenzhen Maternity and Child Healthcare Hospital of Southern Medical University,Shenzhen 518047,China;Department of Neonatology,Qingdao Women and Children′s Hospital of Southern Medical University,Qingdao 266011,China;Department of Neonatology,Guiyang Maternal and Child Health Care Hospital,Guiyong Children's Hospital,Guiyang 550002,China;Department of Neonatology,Gansu Provincial Maternal and Child-care Hospital,Lanzhou 730050,China;Department of Neonatology,Shanghai First Maternal and Infant Hospital,Shanghai 201204,China;Department of Neonatology,the 2nd Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University,Wenzhou 325088,China;Department of Neonatology,the First Affiliated Hospital of Anhui Medical University

机构地区：[1]国家儿童医学中心复旦大学附属儿科医院新生儿科,上海201102 [2]国家儿童医学中心复旦大学附属儿科医院国家卫生健康委员会新生儿疾病重点实验室,上海201102 [3]南京医科大学附属妇产医院新生儿科,南京210004 [4]西北妇女儿童医院新生儿科,西安200001 [5]湖北省妇幼保健院新生儿科,武汉430064 [6]苏州市立医院新生儿科,苏州215008 [7]山西省儿童医院新生儿科,太原030006 [8]福建省妇幼保健院新生儿科,福州350005 [9]南方医科大学附属深圳市妇幼保健院新生儿科,深圳518047 [10]青岛市妇女儿童医院新生儿科,青岛266011 [11]贵阳市妇幼保健院贵阳市儿童医院新生儿科,贵阳550002 [12]甘肃省妇幼保健院新生儿科,兰州730050 [13]上海市第一妇婴保健院新生儿科,上海201204 [14]温州医科大学附属第二医院新生儿科,温州325088 [15]安徽医科大学第一附属医院新生儿科,合肥230022 [16]江西省儿童医院新生儿科,南昌330006 [17]新疆医科大学附属第一医院新生儿科,乌鲁木齐830054 [18]广西壮族自治区妇幼保健院新生儿科,南宁530002 [19]南京医科大学附属儿童医院新生儿科,南京210008 [20]华中科技大学同济医学院附属同济医院新生儿科,武汉430014 [21]河北省儿童医院新生儿科,石家庄050031 [22]无锡市妇幼保健院新生儿科,无锡214002 [23]山东大学附属儿童医院济南市儿童医院新生儿科,济南250022 [24]郑州大学附属儿童医院河南省儿童医院郑州儿童医院新生儿科,郑州450018 [25]首都医科大学附属北京儿童医院新生儿科,北京100045 [26]中南大学湘雅三医院新生儿科,长沙410013 [27]不详

出　　处：《中华儿科杂志》2022年第8期774-780,共7页Chinese Journal of Pediatrics

基　　金：美国中华医学基金会 (14-194)。

摘　　要：目的:分析出生胎龄<34周住院早产儿出院预后及其3年变化趋势。方法:应用“基于证据的质量改进方法降低我国新生儿重症监护室院内感染发生率的整群随机对照试验”所建立的早产儿前瞻性队列数据库的研究数据进行二次分析。纳入25家三级新生儿重症监护病房(NICU)2015年5月至2018年4月在出生7 d内入院的27 192例出生胎龄<34周早产儿,并排除严重先天畸形者。根据出生胎龄和入院时间分组,计算不同出生胎龄住院早产儿出院时病死率和主要并发症发生率。采用Cochran-Armitage检验和Jonckheere-Terpstra检验分析3年间早产儿病死率和并发症发生率的变化趋势;构建多因素Logistic回归模型分析3年间早产儿出院预后的差异。结果:27 192例早产儿出生胎龄(31.3±2.0)周,出生体重(1 617±415)g。自动出院率9.5%(2 594/27 192),总病死率10.7%(2 907/27 192),完整治疗患儿病死率为4.7%(1 147/24 598),完整治疗患儿死亡或主要并发症发生率为26.2%(6 452/24 598)。主要并发症发生率由高至低分别为中重度支气管肺发育不良16.0%(4 342/27 192)、败血症11.9%(3 225/27 192)、重度脑室内出血或脑室周围白质软化6.8%(1 641/24 206)、确诊坏死性小肠结肠炎3.6%(939/25 762)、严重早产儿视网膜病1.5%(214/13 868)。研究期间3年总病死率下降( P<0.001),败血症、严重早产儿视网膜病发生率也均呈下降趋势(均 P<0.001)。完整治疗存活早产儿主要并发症发生率3年差异无统计学意义( P=0.230)。校正混淆因素后,研究第3年总死亡风险显著低于第1年(调整 OR=0.62,95% CI 0.55~0.69, P<0.001),完整治疗患儿死亡或主要并发症、中重度支气管肺发育不良、败血症和严重早产儿视网膜病发生风险也均低(均 P<0.05)。 结论:2015—2018年NICU住院早产儿病死率及主要并发症发生率呈现降低趋势,但死亡或主要并发症发生率仍有较大的下降空间,需持续开展针对性质量�Objective To investigate the incidence and trend of short-term outcomes among preterm infants born<34 weeks′gestation.Methods A secondary analysis of data from the standardized database established by a multicenter cluster-randomized controlled study"reduction of infection in neonatal intensive care units(NICU)using the evidence-based practice for improving quality(REIN-EPIQ)study".This study was conducted in 25 tertiary NICU.A total of 27192 infants with gestational age<34 weeks at birth and admitted to NICU within the first 7 days of life from May 2015 to April 2018 were enrolled.Infants with severe congenital malformation were excluded.Descriptive analyses were used to describe the mortality and major morbidities of preterm infants by gestational age groups and different admission year groups.Cochran-Armitage test and Jonckheere-Terpstra test were used to analyze the trend of incidences of mortality and morbidities in 3 study-years.Multiple Logistic regression model was constructed to analyze the differences of outcomes in 3 study-years adjusting for confounders.Results A total of 27192 preterm infants were enrolled with gestational age of(31.3±2.0)weeks at birth and weight of(1617±415)g at birth.Overall,9.5%(2594/27192)of infants were discharged against medical advice,and the overall mortality rate was 10.7%(2907/27192).Mortality for infants who received complete care was 4.7%(1147/24598),and mortality or any major morbidity was 26.2%(6452/24598).The incidences of moderate to severe bronchopulmonary dysplasia,sepsis,severe intraventricular hemorrhage or periventricular leukomalacia,proven necrotizing enterocolitis,and severe retinopathy of prematurity were 16.0%(4342/27192),11.9%(3225/27192),6.8%(1641/24206),3.6%(939/25762)and 1.5%(214/13868),respectively.There was a decreasing of the overall mortality(P<0.001)during the 3 years.Also,the incidences for sepsis and severe retinopathy of prematurity both decreased(both P<0.001).However,there were no significant differences in the major morbidity in preterm i

关 键 词：重症监护病房 新生儿 婴儿 早产 死亡率 

分 类 号：R722.6[医药卫生—儿科]