不同早产原因对晚期早产儿结局的影响  

Impacts of different causes of preterm birth on the outcomes of late preterm infants

作　　者：王慧 曹丽芳[1] 张雪峰 Hui Wang;Lifang Cao;Xuefeng Zhang(Department of Pediatrics,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院新生儿科,北京102206

出　　处：《中华新生儿科杂志（中英文）》2023年第12期740-744,共5页Chinese Journal of Neonatology

基　　金：北京大学国际医院院内科研基金(YN2021QN07)。

摘　　要：目的探讨不同早产原因对晚期早产儿结局的影响。方法回顾性分析北京大学国际医院2016—2022年分娩的晚期早产儿及其母亲资料, 根据早产原因分为自发性早产组、胎膜早破组和医源性早产组。比较3组母亲围产期特点及新生儿结局, 并通过logistic回归分析不同早产原因与晚期早产儿复合不良结局(包括以下至少一种情况:呼吸系统疾病、需要呼吸支持、新生儿低血糖症、新生儿窒息)的关系。结果共纳入553例晚期早产儿, 自发性早产组111例(20.1%), 胎膜早破组305例(55.2%), 医源性早产组137例(24.8%)。医源性早产组母亲妊娠期高血压、产前使用激素和剖宫产比例、新生儿呼吸系统疾病发生率、呼吸支持率、复合不良结局发生率均高于另外两组, 新生儿出生体重低于另外两组, 差异有统计学意义(P<0.05);自发性早产组和胎膜早破组差异无统计学意义(P>0.05)。医源性早产组胎龄低于胎膜早破组, 新生儿窒息和小于胎龄儿发生率高于胎膜早破组, 差异有统计学意义(P<0.05)。logistic回归分析显示, 与自发性早产相比, 医源性早产(OR=1.983, 95%CI 1.037~3.791)晚期早产儿发生复合不良结局的风险增加;与胎龄36周相比, 胎龄34周(OR=2.412, 95%CI 1.250~4.656)和35周(OR=1.909, 95%CI 1.197~3.044)早产儿发生复合不良结局的风险增加。结论除了胎龄小所致的发育不成熟影响晚期早产儿结局外, 医源性早产也增加晚期早产儿复合不良结局发生率。Objective To study the impacts of different causes of preterm birth on the clinical outcomes of late preterm infants.Methods From 2016 to 2022,clinical data of late preterm infants and their mothers delivered in our hospital were retrospectively analyzed.The infants were assigned into spontaneous preterm group,premature rupture of membranes(PROM)group and iatrogenic preterm group according to the causes of preterm birth.Perinatal data and neonatal outcomes were compared among these groups.Composite neonatal adverse outcomes(CNAO)included more than one of the following conditions:respiratory diseases,the need for respiratory support,hypoglycemia and neonatal asphyxia.Logistic regression analysis was used to analyze the correlation between causes of preterm birth and CNAO.Results A total of 553 late preterm infants were enrolled in the study,including 111 cases(20.1%)in spontaneous preterm group,305 cases(55.2%)in PROM group and 137 cases(24.8%)in iatrogenic preterm group.Iatrogenic preterm group had higher incidences of maternal hypertension during pregnancy,antenatal corticosteroid use,C-section delivery,neonatal respiratory diseases,respiratory support and CNAO than the other two groups(P<0.05).Additionally,iatrogenic preterm group showed lower birth weight(BW)than the other two groups(P<0.05).No significant differences existed in above-mentioned items between spontaneous preterm group and PROM group(P>0.05).Iatrogenic preterm group had significantly lower gestational age(GA)and higher incidences of neonatal asphyxia and small-for-gestational-age(SGA)than PROM group(P<0.05).Logistic regression analysis showed that iatrogenic preterm birth(OR=1.983,95%CI 1.037-3.791)and lower GA at delivery(34 weeks:OR=2.412,95%CI 1.250-4.656;35 weeks:OR=1.909,95%CI 1.197-3.044)were independent risk factors for CNAO in late preterm infants.Conclusions In addition to immaturity caused by lower GA,iatrogenic preterm birth also increases the incidence of CNAO in late preterm infants.

关 键 词：晚期早产儿 自发性早产 医源性早产 胎龄 复合不良结局 

分 类 号：R722.6[医药卫生—儿科]