母亲孕产期因素对晚期早产儿高胆红素血症影响的多中心研究

A multi-center research on risk factors of hyperbilirubinemia in late preterm infants

目的调查晚期早产儿高胆红素血症的发生情况,分析发生高胆红素血症晚期早产儿的母亲孕产期因素及其对晚期早产儿高胆红素血症的影响。方法前瞻性录入晚期早产儿的临床数据,以2015年10月23日至2016年4月30日来自北京地区25家医院的晚期早产儿为研究对象,以其中高胆红素血症患儿为高胆组,无高胆红素血症患儿为对照组,分析比较两组患儿临床资料,并对影响晚期早产儿高胆红素血症的母亲孕产期因素进行logistic回归分析。结果入组晚期早产儿815例,男449例,女366例,其中高胆组患儿340例,发病率41.7%,男198例,女142例,出生体重(2502.6±439.6)g;对照组475例,男251例,女224例,出生体重(2470.2±402.9)g,两组出生体重(t=1.811,P=0.172)、性别(χ^2=2.330,P=0.127)比较差异均无统计学意义。高胆组与对照组比较,各胎龄间高胆红素血症发病率差异无统计学意义(χ^2=1.218,P=0.544)。多因素回归分析显示母亲孕龄增加(OR=1.044,95%CI:1.010~1.080,P=0.011)、妊娠次数增加(OR=1.365,95%CI:0.989~1.883,P=0.048)、胎膜早破(OR=2.350,95%CI:1.440~3.833,P=0.001)、剖宫产(OR=1.540,95%CI:0.588~4.031,P=0.014)是晚期早产儿高胆红素血症发生的独立危险因素。结论晚期早产儿高胆红素血症发生率较高,母亲年龄增大、妊娠次数增加、胎膜早破、剖宫产是晚期早产儿发生高胆红素血症的母亲孕期危险因素,应提高对晚期早产儿高胆红素血症及高危因素的认识以及时诊断。

Objective To investigate the risk factors of hyperbilirubinemia in late preterm infants.Methods The clinical data of 815 late preterm infants (449 males and 366 females) from 25 hospitals inBeijing were collected from October 2015 to April 2016, including 340 cases(41.7%) withhyperbilirubinemia (hyperbilirubinemia group), and 475 cases without hyperbilirubinemia (control group).The clinical data of two groups were compared, and the maternal factors influencing hyperbilirubinemia inlate preterm infants were analyzed with logistic regression. Results There were no significant differences ingender ratio (M∶F 1.39 vs. 1.12, t=1.811,P=0.172)and birth weight[ (2 502.6±439.6)g vs. (2 470.2±402.9)g,χ^2 =2.330,P=0.127)]between two groups. The incidence rates of hyperbilirubinemia in infants of 34 wks, 35wks and 36 wks of gestational age were 22.9 % (87/174), 35% (119/300) and 42.1% (143/341) respectively(χ^2 =1.218,P=0.544). The multivariate logistic regression analysis indicated that the maternal age(OR=1.044,95% CI:1.010-1.080,P=0.011)was independent risk factor and multiple births(OR=1.365,95%CI:0.989 - 1.883,P=0.048), premature rupture of membranes(OR=2.350,95% CI:1.440-3.833,P=0.001), cesarean section(OR=1.540,95% CI:0.588-4.031,P=0.014)were risk factors for hyperbilirubinemiain late preterm infants. Conclusions The incidence of hyperbilirubinemia in late preterm infants isrelatively high. Maternal age, multiple births, premature rupture of membranes and cesarean section are riskmaternal factors related to hyperbilirubinemia in late preterm infants.