小于胎龄极低出生体质量儿晚发型败血症危险因素分析

Risk factors for late onset septicemia in very low birth weight infants born small for gestational age

目的探讨新生儿重症监护室小于胎龄极低出生体质量儿(VLBWI)晚发型败血症的危险因素。方法回顾性分析安徽医科大学第一附属医院新生儿重症监护室2009年1月至2014年12月收治的胎龄<34周、出生体质量<1 500 g、住院时间>7 d VLBWI的相关临床资料,分析其中小于胎龄VLBWI晚发型败血症临床特点、实验室结果、危险因素及预后等。结果 296例纳入本研究的VLBWI中,小于胎龄儿组165例,其中发生晚发型败血症者56例,经单因素分析结果显示,小于胎龄VLBWI晚发型败血症危险因素包括极早产(胎龄<32周)、超低出生体质量(出生体重<1 000 g)、胎膜早破>18 h、预防应用抗菌药物>7 d、经外周中心静脉插管>7 d、经鼻持续气道正压通气、机械通气、留置胃管>7 d、静脉营养时间及住院时间长等。有统计学意义的变量进入logistic多元回归分析显示,其独立危险因素为留置胃管>7 d和胎膜早破>18 h。结论在VLBWI中小于胎龄儿更易发生晚发型败血症,今后临床工作中应对这一特殊群体采取个性化预防措施,凡胎膜早破>18 h者需动态连续监测血象指标,尽早开始经口肠道微量喂养,缩短留置胃管时间。

Objective To investigate the risk factors for late onset septicemia( LOS) in very low birth weight( VLBW) infants born small for gestational age( SGA). Methods The VLBW infants whose birth weight were less than 1500 g and hospital stays were more than 7days in neonatal intensive care unit( NICU) of The First Affiliated Hospital of Anhui Medical University from January 2009 to December 2014 were analyzed retrospectively. Outcomes were compared between VLBW infants born SGA( birth weight less than tenth percentile according to gestational age and gender) and non-SGA infants. Clinical characteristics,laboratory features,risk factors and prognosis of VLBWI born small for gestational age with late onset septicemia were analyzed. Result 296 VLBW infants were included,of them,165 cases were SGA,among them 56 episodes of late onset septicemia were identified.. Univariate analysis indicated that the related risk factors including very preterm infants( GA < 32W),extremely low birth weight infants( BW < 1000g),birth weight,premature rupture of amniotic membrane > 18 h,antibioti cs > 7 days,Peripherally Inserted Central Cathete( PICC) > 7 days,Nasal continuous positive airway pressure( NCPAP),mechanical ventilation,gastric tube placing > 7 days,parenteral nutrition,hospitalization. Multivariate logistic regression analysis showed that gastric tube placi ng > 7 days and premature rupture of amniotic membrane > 18 h were independent risk factors for late onset septicemia in VLBW infants born small for gestational age. Conclusion SGA contributes to the risk of late onset septicemia in VLBW infants. Future studies are needed to guide individualized preventive measures in this vulnerable subgroup.