出生胎龄<32周极早产儿早发型脓毒症与住院期间不良结局关系的多中心队列研究  

Relationship between early-onset sepsis and adverse outcomes during hospitalization in very preterm infants with gestational age less than 32 weeks:a multicenter 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 Yu Yonghui;Yu Yonghui(不详;Department of Pediatrics,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]不详 [2]山东第一医科大学附属省立医院儿科,济南250021

出　　处：《中华围产医学杂志》2024年第11期899-907,共9页Chinese Journal of Perinatal Medicine

基　　金：山东省自然科学基金(ZR2023MH175);山东省医学会临床科研资金-齐鲁专项(YXH2022DZX02001)。

摘　　要：目的探讨出生胎龄<32周极早产儿早发型脓毒症(early-onset sepsis,EOS)的临床特征及其与住院期间不良结局的关系。方法本研究为多中心队列研究,数据来源于中国北方新生儿协作网,纳入并分析2018年1月1日至2022年12月31日43家协作单位新生儿重症监护病房收治的出生胎龄<32周极早产儿的一般资料、围产期情况、临床特征及住院期间不良结局。根据是否发生EOS,分为EOS组和非EOS组。主要结局指标包括死亡和/或Ⅲ~Ⅳ度脑室内出血,次要结局指标包括中重度支气管肺发育不良、≥Ⅱ期新生儿坏死性小肠结肠炎、≥3期早产儿视网膜病变、5 min Apgar评分≤7分及产房内气管插管。采用χ²检验、Mann-Whitney U检验及多因素logistic回归模型,分析EOS与极早产儿住院期间不良结局的关系。结果(1)研究期间共纳入符合条件的极早产儿7154例,EOS发生率为14.1%(1008/7154),其中出生体重<1000 g超低出生体重儿和出生胎龄<28周超早产儿EOS的发生率分别为26.0%(293/1126)和30.2%(325/1076)。(2)单因素分析显示,与非EOS组相比,EOS组死亡[17.9%(180/1008)与5.2%(322/6146),χ^(2)=211.31]、Ⅲ~Ⅳ度脑室内出血[16.4%(165/1008)与4.5%(276/6146),χ^(2)=221.23]、死亡或Ⅲ~Ⅳ度脑室内出血[23.6%(238/1008)与7.7%(476/6146),χ^(2)=242.64]、5 min Apgar评分≤7分[33.7%(340/1008)与20.7%(1273/6146),χ^(2)=84.03]、产房内气管插管[39.4%(397/1008)与21.3%(1307/6146),χ^(2)=156.68]、中重度支气管肺发育不良[13.0%(131/1008)与7.5%(464/6146),χ^(2)=33.69]、≥Ⅱ期新生儿坏死性小肠结肠炎[4.3%(43/1008)与2.9%(178/6146),χ^(2)=5.43]、≥3期早产儿视网膜病变[5.8%(58/1008)与3.1%(191/6146),χ^(2)=18.05]的发生率均较高(P值均<0.05)。(3)多因素logistic回归分析显示,EOS是极早产儿死亡(aOR=2.262,95%CI:1.810~2.827,P<0.001)、Ⅲ~Ⅳ度脑室内出血(aOR=2.623,95%CI:2.089~3.293,P<0.001)以及死亡或Ⅲ~Ⅳ度脑室内出血(aOR=2.251,95%CI:1.852~2.737ObjectiveTo investigate the clinical characteristics of early-onset sepsis(EOS)in very preterm infants with gestational age(GA)<32 weeks and their relationship with adverse outcomes during hospitalization.MethodsA multicenter cohort study was conducted using data from the Sino-northern Neonatal Network(SNN).Clinical data including general information,perinatal conditions,clinical characteristics,and adverse outcomes during hospitalization of very preterm infants with GA<32 weeks admitted to neonatal intensive care units(NICUs)of 43 collaborative units from January 1,2018,to December 31,2022,were collected and analyzed.These infants were divided into EOS and non-EOS groups based on the diagnostic criteria of EOS.The primary outcomes included death and/or gradeⅢ-Ⅳintraventricular hemorrhage(IVH).The secondary outcomes included moderate to severe bronchopulmonary dysplasia(BPD),stageⅡor above necrotizing enterocolitis(NEC),stage 3 or above retinopathy of prematurity(ROP),Apgar score≤7 at 5 min,and delivery room intubation.The relationship between EOS and adverse outcomes during hospitalization in very preterm infants was analyzed using Chi-square test,Mann-Whitney U test,and multivariate logistic regression models.Results(1)A total of 7154 very preterm infants were included during the study period,and 14.1%(1008/7154)of them developed EOS.The incidence of EOS was 26.0%(293/1126)in infants with birth weight<1000 g(extremely low birth weight)and 30.2%(325/1076)in infants with GA<28 weeks(extremely preterm).(2)Univariate analysis showed that compared with the non-EOS group,the EOS group had a higher incidence of death[17.9%(180/1008)vs.5.2%(322/6146),χ^(2)=211.31],gradeⅢ-ⅣIVH[16.4%(165/1008)vs.4.5%(276/6146),χ^(2)=221.23],death or gradeⅢ-ⅣIVH[23.6%(238/1008)vs.7.7%(476/6146),χ^(2)=242.64],Apgar score≤7 at 5 min[33.7%(340/1008)vs.20.7%(1273/6146),χ^(2)=84.03],intubation in the delivery room[39.4%(397/1008)vs.21.3%(1307/6146),χ^(2)=156.68],moderate to severe BPD[13.0%(131/1008)vs.7.5%(464/6146),χ^

关 键 词：新生 极早产儿 早发型脓毒症 预后 队列研究 

分 类 号：R722.6[医药卫生—儿科]