出生胎龄<32周早产儿生后1周内死亡或严重脑室内出血的围生期因素分析  

Analysis of perinatal factors for death or severe intraventricular hemorrhage within the first week of life in preterm infants with gestational age<32 weeks

作　　者：王露冉 刘学丽 杨翠红 于永慧 刘静 中国北方新生儿协作网多中心协作组 Wang Luran;Liu Xueli;Yang Cuihong;Yu Yonghui;Liu Jing;Sino-northern Neonatal Network Collaborative Group(Department of Neonatology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250014,China;不详)

机构地区：[1]山东第一医科大学附属省立医院新生儿科,济南250014 [2]不详

出　　处：《中华儿科杂志》2025年第4期387-393,共7页Chinese Journal of Pediatrics

基　　金：国家自然科学基金(82470824);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：目的分析出生胎龄<32周早产儿生后1周内死亡或严重脑室内出血(sIVH)的发生情况及其围生期因素。方法基于中国北方新生儿协作网在线数据平台,采用病例-对照研究设计,纳入2019至2023年35家新生儿重症监护病房(NICU)收治的8903例出生胎龄<32周的早产儿。按出生胎龄分为极早产儿和超早产儿,每组再将生后1周内死亡或发生sIVH的早产儿纳入病例组,无sIVH存活的早产儿纳入对照组。分别比较分析极早产儿和超早产儿病例组和对照组的一般情况、母亲围生期情况、第5分钟Apgar评分、入院低体温、早发型败血症、第1次动脉血pH值。采用χ2检验、Wilcoxon秩和检验进行组间比较。多因素Logistic回归模型分析出生胎龄<32周早产儿生后1周内死亡或sIVH的围生期因素。结果8903例出生胎龄<32周的早产儿中男4993例(56.1%),出生胎龄为30.0(28.4,31.0)周,生后1周内死亡或sIVH共865例(9.7%)。极早产儿和超早产儿病例组占比分别为5.8%(426/7316)、27.7%(439/1587)。与对照组相比,极早及超早产儿病例组出生胎龄、出生体重均更低,小于胎龄、第5分钟Apgar评分≤7分、早发型败血症、入院低体温、第1次动脉血pH值<7.20的比例均更高,母产前足疗程应用糖皮质激素比例均更低(均P<0.001)。多因素Logistic回归分析显示,极早及超早儿生后1周内死亡或sIVH的共同危险因素有小出生胎龄(OR=0.70、0.74,95%CI 0.60~0.82、0.66~0.83,均P<0.001)、低出生体重(OR=0.99、0.99,95%CI 0.99~1.00、0.99~1.00,均P<0.05)、早发型败血症(OR=1.82、2.20,95%CI 1.42~2.34、1.74~2.79,均P<0.001)、第5分钟Apgar评分≤7分(OR=1.41、2.69,95%CI 1.10~1.81、2.17~3.34,均P<0.01)、入院低体温(OR=1.55、1.38,95%CI 1.17~2.07、1.08~1.76,均P<0.05)及第1次动脉血pH值<7.20(OR=2.20、2.57,95%CI 1.70~2.84、2.05~3.21,均P<0.001);多胎仅为超早产儿的独立危险因素(OR=1.32,95%CI 1.02~1.71,P<0.05);母产前足疗程糖皮质激素是极Objective To analyze the incidence and perinatal factors of death or severe intraventricular hemorrhage(sIVH)within the first week of life in preterm infants with gestational age<32 weeks.Methods Based on the online data platform of Sina-northern Neonatal Network,a case-control study was conducted using clinical data from 8903 preterm infants with gestational age<32 weeks admitted to 35 neonatal intensive care unit(NICU)between 2019 and 2023.Infants were classified by gestational age at birth into very preterm infants and extremely preterm infants.Infants who died or developed sIVH within the first week of life were defined as the case group,while those who survived and did not develop sIVH were defined as the control group.The general information of the infants,maternal perinatal factors,the 5 th minute Apgar score,incidence of hypothermia or early-onset sepsis,and the first arterial blood pH value were compared between the case and control groups of very preterm infants and extremely preterm infants.Theχ²test and Wilcoxon rank-sum test were used for intergroup comparisons.A multivariable logistic regression model was used to analyze the factors for death or sIVH within the first week of life in very preterm and extremely preterm infants.Results Among the 8903 preterm infants with gestational age<32 weeks,4993(56.1%)were male,with a gestational age at birth of 30.0(28.4,31.0)weeks.A total of 865 cases(9.7%)were death or sIVH within the first week of life.The case group took up 5.8%(426/7316)and 27.7%(439/1587)of very preterm infants and extremely preterm infants,respectively.Compared to the control group,the case group of very preterm and extremely preterm infants both had higher incidences of low gestational age,low birth weight,small for gestational age,the 5 th minute Apgar score≤7,early-onset sepsis,hypothermia at admission,and first arterial blood pH<7.20(all P<0.001).The proportion of mother′s full course antenatal corticosteroids use were both lower in both case group(both P<0.001).Multivariate Logi

关 键 词：婴儿 早产 危险因素 死亡 脑室内出血 

分 类 号：R722.6[医药卫生—儿科]