极早产儿的早产原因及其对住院期间不良结局的影响:多中心前瞻性队列研究  

Etiology of preterm birth and in-hospital adverse outcome of very preterm infants:a multicenter prospective observational cohort study

作　　者：中国北方新生儿协作网多中心协作组 于永慧 Sino-Northern Neonatal Network Collaborative Group

机构地区：[1]不详 [2]山东第一医科大学附属省立医院新生儿科

出　　处：《中华围产医学杂志》2023年第5期357-365,共9页Chinese Journal of Perinatal Medicine

基　　金：山东省医学会临床科研资金-齐鲁专项(YXH2022DZX02001)。

摘　　要：目的探讨新生儿重症监护病房(neonatal intensive care unit,NICU)中胎龄<32周极早产儿的主要早产原因,以及这些因素对患儿住院期间死亡和主要并发症等不良结局的影响。方法本研究为前瞻性观察性队列研究。研究对象为中国北方新生儿协作网(Sino-Northern Neonatal Network,SNN)50家参与单位2018年1月1日至2021年12月31日收治的胎龄<32周单胎极早产儿。根据早产的主要原因分为6组,包括妊娠期高血压疾病(hypertensive disorders of pregnancy,HDP)、自发性早产、未足月胎膜早破(preterm premature rupture of membranes,PPROM)、绒毛膜羊膜炎、产前出血和其他原因。采用χ^(2)检验、t检验、秩和检验和多因素logistic回归等统计方法分析不同早产原因组极早产儿的人口学特征、围产期情况,以及各导致早产的因素对患儿主要不良结局[院内死亡、脑室内出血(intraventricular hemorrhage,IVH)、早发型败血症(early-onset sepsis,EOS)或晚发型败血症(late-onset sepsis,LOS)、中-重度支气管肺发育不良(bronchopulmonary dysplasia,BPD)、宫外生长发育迟缓(extrauterine growth retardation,EUGR)、小于胎龄儿(small for gestational age,SGA)、坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、脑室周围白质软化(periventricular leukomalacia,PVL)和早产儿视网膜病变(retinopathy of prematurity,ROP)]的影响。结果(1)研究期间共纳入胎龄<32周单胎极早产儿5351例,其中男性2971例(55.5%),胎龄<28周的超早产儿682例(12.7%)。(2)5351例极早产儿的早产原因依次为母体HDP(1569例,29.3%)、自发性早产(1450例,27.0%)、PPROM(1174例,21.9%)、绒毛膜羊膜炎(599例,11.2%)、产前出血(361例,6.7%)及其他原因(198例,3.7%)。其中682例超早产儿的早产原因依次为自发性早产(236例,34.6%)、PPROM(145例,21.3%)、HDP(121例,17.7%)、绒毛膜羊膜炎(116例,17.0%)、产前出血(44例,6.5%)及其他原因(20例,2.9%)。HDP组出生体重最低[1200 g(1000~1400 g),Objective To investigate the etiology of preterm birth before 32 gestational weeks and the impact of those factors on in-hospital death and major complications of live-born,very premature infants.Methods This prospective observational cohort study was conducted on all very preterm singleton infants with gestational age<32 weeks who were admitted to the neonatal intensive care unit(NICU)of 50 member units of the Sino-Northern Neonatal Network(SNN)from January 1,2018,to December 31,2021.According to the leading causes of preterm birth,all subjects were divided into six groups,including the hypertensive disorder in pregnancy(HDP)group,spontaneous preterm birth with intact membranes(spontaneous)group,premature rupture of membranes(PPROM)group,chorioamnionitis(CA)group,prenatal hemorrhage group,and others.Univariate t-tests,rank-sum tests,Chi-square tests,and multivariate logistic regression analysis were applied to analyze the demographic characteristics,perinatal conditions,and different factors of preterm birth on adverse outcomes of the infants,such as mortality rate and major complications[intraventricular hemorrhage(IVH),early-or late-onset sepsis(EOS/LOS),bronchopulmonary dysplasia(BPD),extrauterine growth retardation(EUGR),small for gestational age(SGA),necrotizing enterocolitis(NEC)and periventricular leukomalacia(PVL)]during hospitalization.Results(1)Totally,5351 preterm infants were enrolled participants.Among them,2971 were male(55.5%),and 682(12.7%)were extremely preterm infants with a gestational age of less than 28 weeks.(2)The leading causes of preterm birth were HDP(n=1569,29.3%),followed by spontaneous preterm birth(n=1450,27.0%),PPROM(n=1174,21.9%),chorioamnionitis(n=599,11.2%),prenatal hemorrhage(n=361,6.7%),and others(n=198,3.7%).For those extremely preterm infants,the causes were spontaneous preterm birth(n=236,34.6%),PPROM(n=145,21.3%),HDP(n=121,17.7%),chorioamnionitis(n=116,17.0%),prenatal hemorrhage(n=44,6.5%)and others(n=20,2.9%).The HDP group had the lowest birth weight[1200 g(1000-1400 g),Z

关 键 词：婴儿 极度早产 早产 预后 队列研究 

分 类 号：R722.6[医药卫生—儿科]