住院期间母乳量占比对胎龄<34周早产儿抗菌药物使用时间的影响:多中心回顾性队列研究  

Effects of breast milk intake ratio during hospitalization on antibiotic therapy duration in preterm infants less than 34 gestational weeks:a multicenter retrospective cohort study

作　　者：顾成鹏 陈文娟 韩树萍[2] 高艳[1] 朱荣平 张纪华[4] 陈蓉蓉 徐艳 姜善雨[7] 张宇涵 路星星 薛梅[10] 吴明赴[11] 潘兆军[12] 陈冬梅 郝晓波 吴新萍[15] 万俊[16] 王淮燕 刘松林[4] 叶丹妮 陈筱青 侯玮玮[9] 杨丽[10] Gu Chengpeng;Chen Wenjuan;Han Shuping;Gao Yan;Zhu Rongping;Zhang Jihua;Chen Rongrong;Xu Yan;Jiang Shanyu;Zhang Yuhan;Lu Xingxing;Xue Mei;Wu Mingfu;Pan Zhaojun;Chen Dongmei;Hao Xiaobo;Wu Xinping;Wan Jun;Wang Huaiyan;Liu Songlin;Ye Danni;Chen Xiaoqing;Hou Weiweit;Yang Li(Department of Neonatology,Lianyungang Maternal and Child Health Hospital,Lianyungang 222000,China;Department of Neonatology,Women's Hospital of Nanjing Medical University(Nanjing Maternity and Child Health Care Hospital),Nanjing 210004,China;Department of Neonatology,Changzhou Maternal and Child Health Care Hospital,Changzhou 213000,China;Department of Neonatology,Xuzhou Maternal and Child Health Care Hospital,Xuzhou 221009,China;Department of Neonatology,Nantong Maternal and Child Health Care Hospital,Nantong 226018,China;Department of Neonatology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China;Department of Neonatology,Wuxi Woman and Enfants Care Hospital,Wuxi 214002,China;Department of Neonatology,First Affliated Hospital with Nanjing Medical University,Nanjing 210029,China;Department of Neonatology,Northern Jiangsu People's Hospital,Yangzhou 225001,China;Department of Neonatology,Jiangsu Taizhou People's Hospital,Taizhou 225300,China;Department of Neonatology.Afiliated Hospital of Yangzhou University,Yangzhou 225001,China;Department of Neonatology,Jiangsu Huai'an Maternity and Children Hospital,Huai'an 223002,China;Department of Neonatology,Quanzhou Women's and Children's Hospital,Quanzhou 362000,China;Department of Neonatology,Affiliated Hospital of Jiangsu University,Zhenjiang 212000,China;Department of Neonatology,Yangzhou Maternal and Child Care Service Centre,Yangzhou 225002,China;Department of Neonatology,Jiangyin People's Hospital,Jiangyin 214400,China)

机构地区：[1]连云港市妇幼保健院新生儿科,连云港222000 [2]南京医科大学附属妇产医院(南京市妇幼保健院)新生儿科,南京210004 [3]常州市妇幼保健院新生儿科,常州213000 [4]徐州市妇幼保健院新生儿科,徐州221009 [5]南通市妇幼保健院新生儿科,南通226018 [6]徐州医科大学附属医院新生儿科,徐州221000 [7]无锡市妇幼保健院新生儿科,无锡214002 [8]南京医科大学第一附属医院新生儿科,南京210029 [9]江苏省苏北人民医院新生儿科,扬州225001 [10]泰州市人民医院新生儿科,泰州225300 [11]扬州大学附属医院新生儿科,扬州225001 [12]淮安市妇幼保健院新生儿科,淮安223002 [13]泉州市妇幼保健院·儿童医院新生儿科,泉州362000 [14]江苏大学附属医院新生儿科,镇江212000 [15]扬州市妇幼保健院新生儿科,扬州225002 [16]江阴市人民医院新生儿科,江阴214400

出　　处：《中华围产医学杂志》2023年第7期546-553,共8页Chinese Journal of Perinatal Medicine

基　　金：南京市医学科技发展基金(ZKX19045)。

摘　　要：目的:探讨住院期间不同母乳量占比对胎龄<34周早产儿抗菌药物使用时间的影响。方法:回顾性纳入2019年1月1日至2021年12月31日江苏省新生儿围产期协作网16家医院胎龄<34周的早产儿(n=1792)。以抗菌药物的治疗天数(days of therapy,DOT)评估抗菌药物使用时间,中位数为15.0 d(7.0~27.0 d),再根据DOT的四分位数进行分组,分别为Q_(1)组(DOT≤7.0 d)、Q_(2)组(7.0 d<DOT≤15.0 d)、Q_(3)组(15.0 d<DOT≤27.0 d)和Q_(4)组(DOT>27.0 d)。母乳量占比(住院期间母乳喂养量/总喂养量×100%)按由低到高分为4组,分别为极低母乳量占比组(母乳量占比≤25%)、低母乳量占比组(25%<母乳量占比≤50%)、中母乳量占比组(50%<母乳量占比≤75%)和高母乳量占比组(母乳量占比>75%)。采用单因素分析(χ^(2)检验和Kruskal-Wallis秩和检验)筛选DOT的影响因素,并分别行Spearman相关分析和趋势χ^(2)检验探讨母乳量占比与DOT之间的关系。采用多重插补后数据集,通过校正不同因素构建2个模型,运用无序多分类logistic回归模型评估母乳量占比对DOT的效应,最后进行敏感性分析评估模型稳定性。结果:(1)纳入的早产儿中Q_(1)组507例(28.3%),Q_(2)组422例(23.5%),Q_(3)组438例(24.4%),Q_(4)组425例(23.7%)。(2)极低、低、中、高母乳量占比组中DOT中位数分别为20.0 d(11.0~31.0 d)、20.0 d(11.0~32.0 d)、13.0 d(6.0~25.8 d)、10.0 d(4.0~21.0 d),与极低、低母乳量占比组分别比较,中、高母乳量占比组DOT更低(P值均<0.05)。(3)校正抗菌药物DOT四分位组间P<0.1的因素(产前使用糖皮质激素、分娩前24 h内使用抗菌药物、出生胎龄、出生体重、1 min Apgar评分≤7分、新生儿呼吸窘迫综合征、感染性肺炎和新生儿早发型败血症)后,与Q_(1)组相比,Q_(2)、Q_(3)、Q_(4)组里中、高母乳量占比组相比于极低母乳量占比组是保护因素(Q_(2):中母乳量占比组OR=0.50,95%CI:0.30~0.85;高母乳量占比组OR=0.36,95%CI:0.26~0.Objective To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods Clinical data of preterm infants(n=1792)less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1,2019,to December 31,2021.The days of therapy(DOT)were used to evaluate the duration of antibiotic administration.The median DOT was 15.0 d(7.0-27.0 d).The patients were divided into four groups based on the quartiles of DOT:Q_(1)(DOT≤7.0 d),Q_(2)(7.0 d<DOT≤15.0 d),Q_(3)(15.0 d<DOT≤27.0 d)and Q_(4)(DOT>27.0 d)groups.According to the breast milk intake ratio(breast milk intake to total milk intake during hospitalization×100%),they were also divided into four groups:very-low-ratio breastfeeding group(breast milk intake ratio≤25%),low-ratio breastfeeding group(25%<breast milk intake ratio≤50%),medium-ratio breastfeeding group(50%<breast milk intake ratio≤75%)and high-ratio breastfeeding group(breast milk intake ratio>75%).Univariate analysis(Chi-square test and Kruskal-Wallis rank-sum test)was used to analyze the factors influencing DOT.Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT.After using multiple imputations to address missing data,two models were constructed after adjusting for different factors,and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT.Finally,sensitivity analysis was conducted to assess the stability of the models.Results(1)Of the 1792 preterm infants,there were 507(28.3%)in the Q_(1) group,422(23.5%)in the Q_(2) group,438(24.4%)in the Q_(3) group and 425(23.7%)in the Q_(4) group.(2)The median values of DOT in the very-low-ratio,low-ratio,medium-ratio and high-ratio breastfeeding groups were 20.0 d(11.0-31.0 d),20.0 d(11.0-32.0 d),13.0 d(6.0-25.8 d)an

关 键 词：母乳喂养 抗菌药 婴儿 早产 药物时间疗法 影响因素分析 

分 类 号：R722.6[医药卫生—儿科]