新生儿缺氧缺血性脑病中喂养困难的临床特征和高危因素分析  

Clinical characteristic and risk factors for feeding difficulties in neonates with hypoxic-ischemic encephalopathy

作　　者：钱天阳 高婷 邱寒 张鹏 程国强 王来栓 QIAN Tian-yang;GAO Ting;QIU Han;ZHANG Peng;CHENG Guo-qiang;WANG Lai-shuan(National Health Commission(NHC)Key Laboratory of Neonatal Diseases/Department of Neonatology,Children’s Hospital,Fudan University,Shanghai 201102,China)

机构地区：[1]国家卫生和健康委员会新生儿疾病重点实验室/复旦大学附属儿科医院新生儿科,上海201102

出　　处：《复旦学报（医学版）》2023年第3期405-411,共7页Fudan University Journal of Medical Sciences

摘　　要：目的探究新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)喂养困难的临床特征以及高危因素。方法本研究为病例对照研究,纳入复旦大学附属儿科医院2013年1月—2021年9月NICU住院的所有HIE新生儿。根据喂养困难标准分为喂养困难和无喂养困难两组。采集患儿暴露因素和临床检查评分,行单因素分析和Logistic回归分析探究HIE患儿喂养困难的临床特征以及高危因素。结果收治270例HIE患儿,共计176例HIE患儿纳入本研究,其中喂养困难组72例(40.9%),无喂养困难组104例(59.1%)。HIE患儿喂养困难组住院天数长于无喂养困难组[19天(15,29.75)vs.12天(10,15),P<0.001];喂养困难组死亡率高于无喂养困难组(5%vs.0,P=0.027)。喂养困难组患儿合并新生儿惊厥(25%vs.12.5%,P=0.044)、新生儿败血症(33.3%vs.7.3%,P=0.019)、新生儿肺炎(30.6%vs.17.3%,P=0.045)、呼吸衰竭(31.9%vs.17.3%,P=0.030)的比例高于无喂养困难组。喂养困难组患儿接受机械通气的比例明显高于无喂养困难组(80.6%vs.41.39%,P<0.001),且接受机械通气天数更长[4.5天(1,9)vs.0天(0,2),P<0.001]。喂养困难组接受亚低温治疗的比例显著低于无喂养困难组(38.9%vs.72.1%,P<0.001)。Logistic回归分析示:HIE患儿接受亚低温治疗降低喂养困难风险(OR:0.290,95%CI:0.118~0.715,P=0.007);机械通气时间越长,患儿发生喂养困难风险越高(OR:1.384,95%CI:1.184~1.618,P<0.001);HIE临床分度越严重,患儿发生喂养困难的风险越高(OR:3.029,95%CI:1.279~7.174,P=0.012)。结论HIE患儿发生喂养困难的高危因素主要有接受长时间机械通气、高HIE临床分度、未接受亚低温治疗。应尽可能为具有指征的HIE患儿行亚低温治疗。Objective To investigate the clinical characteristic and high-risk factors of feeding difficulties(FD)in neonates with hypoxic-ischemic encephalopathy(HIE).Methods This is a single center case-control study.We enrolled all the HIE neonates hospitalized in NICU from Jan 2013 to Sep 2021 in Children’s Hospital of Fudan University.The included neonates were divided into feeding difficulties(FD)group and non-feeding difficulties(NFD)group according to diagnostic criteria.The exposure factors and clinical examination scores were collected and analyzed.Univariate analysis and logistic regression analysis were performed to investigate the high-risk factors and clinical characteristic of FD in neonates with HIE.Results A total of 270 neonates met the HIE inclusion criteria,of which 176 neonates were included in the analysis,and 72(40.9%)had FD and 104(59.1%)had NFD.The hospital stay in the FD group was longer than that in the NFD group[19 days(15,29.75)vs.12 days(10,15),P<0.001];the FD group mortality was higher than NFD group(5%vs.0,P=0.027).The proportion of neonates in the FD group with neonatal convulsions(25%vs.12.5%,P=0.044),neonatal sepsis(33.3%vs.17.3%,P=0.019),neonatal pneumonia(30.6%vs.17.3%,P=0.045),neonatal respiratory failure(31.9%vs.17.3%,P=0.030)were higher than that in the NFD group.The proportion of neonates receiving mechanical ventilation in the FD group was significantly higher than that in the NFD group(80.6%vs.41.39%,P<0.001),and the days of receiving mechanical ventilation was longer[4.5 days(1,9)vs.0 days(0,2),P<0.001].The proportion of neonates receiving therapeutic hypothermia(TH)in the FD group was significantly lower than that in the NFD group(38.9%vs.72.1%,P<0.001).Logistic regression analysis showed that receiving TH reduced the odds of FD(OR:0.290,95%CI:0.118-0.715,P=0.007),the longer the mechanical ventilation(OR:1.384,95%CI:1.184-1.618,P<0.001)and the more serious the HIE(OR:3.029,95%CI:1.279-7.174,P=0.012),the higher the odds of FD.Conclusion High-risk factors for FD in neonates with H

关 键 词：新生儿 缺氧缺血性脑病(HIE) 喂养困难 高危因素 临床特征 

分 类 号：R722.19[医药卫生—儿科]