生后院际转运时间对极早产儿临床特征及出院结局的影响  

Clinical features and outcomes at discharge of outborn very preterm infants of different ages after interhospital transfer

作　　者：朱玉茹 顾昕玥 徐发林[3] 赵芳萍[1] 夏磊[3] 曹云 孙建华[5] 石静云[1] 中国新生儿协作网 Zhu Yuru;Gu Xinyue;Xu Falin;Zhao Fangping;Xia Lei;Cao Yun;Sun Jianhua;Shi Jingyun;无(Department 1 of Neonatology,Gansu Provincial Maternity and Child Care Hospital,Lanzhou 730050,China;National Health Commission(NHC)Key Laboratory of Neonatal Diseases(Fudan University),Shanghai 201102,China;Henan Clinical Medical Research Centre of Pediatric Diseases(Advanced Medical Research Center of Zhengzhou University Department of Pediatrics,the Third Affiliated Hospital of Zhengzhou University),Zhengzhou 450052,China;National Children's Medical Center(Department of Neonatology,Children′s Hospital of Fudan University),Shanghai 201102,China;Department of Neonatology,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Chinese Neonatal)

机构地区：[1]甘肃省妇幼保健院新生儿一部,兰州730050 [2]国家卫生健康委员会新生儿疾病重点实验室(复旦大学),上海201102 [3]河南省儿科疾病临床医学研究中心(郑州大学先进医学研究中心,郑州大学附属第三医院儿科),郑州450052 [4]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 [5]上海交通大学医学院附属上海儿童医学中心新生儿科,上海200127 [6]不详

出　　处：《中华围产医学杂志》2023年第5期384-390,共7页Chinese Journal of Perinatal Medicine

摘　　要：目的分析国内院际转运极早产儿日龄分布情况,总结不同日龄转运极早产儿的围产期特征、出院结局以及住院期间治疗情况的差异。方法回顾性纳入2019年全年中国新生儿协作网(Chinese Neonatal Network,CHNN)极早产儿队列中胎龄24~31周^(+6)、在外院出生后转入CHNN新生儿重症监护病房(neonatal intensive care unit,NICU)救治的、排除严重先天畸形的极早产儿3405例。按照转运进入CHNN NICU的日龄分为早期转运组(≤1 d)、延迟转运组(>1~7 d)和晚期转运组(>7 d)。采用方差分析、t检验、χ^(2)检验(两两比较采用Bonferroni校正)、Kruskal-Wallis检验及Wilcoxon秩和检验比较3组极早产儿的一般临床情况、治疗情况及出院结局的差异。结果3405例极早产儿的中位胎龄为29.7周(28.3~31.0周),平均出生体重为(1321.0±316.5)g。早期转运组2031例(59.6%),延迟转运组406例(11.9%),晚期转运组968例(28.4%)。转运极早产儿产房内接受持续气道正压通气的比例为8.4%(237/2806),产房内气管插管比例为32.9%(924/2805)。共62.7%(1569/2504)的患儿母亲接受产前糖皮质激素治疗,早期转运组接受产前糖皮质激素治疗的比例为68.7%(1121/1631),高于延迟转运组[56.1%(152/271),χ^(2)=16.78,P<0.017]和晚期转运组[49.2%(296/602),χ^(2)=72.56,P<0.017]。转运极早产儿总死亡率为12.7%(431/3405),其中早期、延迟及晚期转运组患儿的死亡率分别为12.4%(252/2031)、16.3%(66/406)和11.7%(113/968),组间差异无统计学意义(χ^(2)=5.72,P=0.057)。延迟转运组和晚期转运组患儿重度脑室内出血、晚发型败血症、新生儿坏死性小肠结肠炎和纠正胎龄36周或出院时支气管肺发育不良的发生率高于早期转运组,晚期转运组患儿早产儿视网膜病变、接受治疗的早产儿视网膜病变和纠正胎龄36周或出院时支气管肺发育不良的发生率高于延迟转运组,差异均有统计学意义(Bonferroni校正法,P值均<0.017)。晚期转�Objective To analyze the distribution of ages at the interhospital transfer of outborn very preterm infants in China and to compare their perinatal characteristics and outcomes at discharge and neonatal intensive care unit(NICU)treatment.Methods A total of 3405 outborn very premature infants with a gestational age of 24-31^(+6) weeks who were transferred to the NICUs of the Chinese Neonatal Network(CHNN)in 2019 were included in this retrospective study.According to the age at transfer,they were divided into three groups:early transfer(≤1 d),delayed transfer(>1-7 d)and late transfer(>7 d)groups.Analysis of variance,t-test,Chi-square test(Bonferroni correction),Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare the general clinical condition,treatment,and outcomes at discharge among the three groups.Results The median gestational age was 29.7 weeks(28.3-31.0 weeks)and the average birth weight was(1321.0±316.5)g for these 3405 infants.There were 2031 patients(59.6%)in the early transfer group,406(11.9%)in the delayed transfer group and 968(28.4%)in the late transfer group.Infants who received continuous positive airway pressure ventilation and tracheal intubation in the delivery room accounted for 8.4%(237/2806)and 32.9%(924/2805),respectively.A total of 62.7%(1569/2504)of the mothers received antenatal glucocorticoid therapy and the ratio in the early transfer group was 68.7%(1121/1631),which was higher than that in the delayed transfer group[56.1%(152/271),χ^(2)=16.78,P<0.017]and the late transfer group[49.2%(296/602),χ^(2)=72.56,P<0.017].The total mortality rate of very premature infants was 12.7%(431/3405),and the mortality rates in the early,delayed and late transfer groups were 12.4%(252/2031),16.3%(66/406)and 11.7%(113/968),respectively(χ^(2)=5.72,P=0.057).The incidences of severe intraventricular hemorrhage,late-onset sepsis,necrotizing enterocolitis,and bronchopulmonary dysplasia at the corrected gestational age of 36 weeks or discharge were all higher in the delayed and late transfer

关 键 词：婴儿 极度早产 病人转送 时间因素 重症监护病房 新生儿 时间治疗学 

分 类 号：R722.6[医药卫生—儿科]