超早产儿死亡预后影响因素分析

Predictive factors of mortality in extremely preterm infants

目的分析超早产儿死亡预后影响因素。方法回顾性分析温州医科大学附属第二医院育英儿童医院新生儿科1999年1月1日至2015年12月31日收治的268例超早产儿，按预后分为存活组（192例）和死亡组（76例）。采用病例对照研究方法，对存活组和死亡组通过单因素筛选，再通过多因素非条件逐步Logistic回归分析超早产儿预后影响因素。同时比较1999年1月1日至2007年12月31日（65例）和2008年1月1日至2015年12月31日（203例）2个时间段出生的超早产儿的存活情况及单因素分析其死亡预后影响因素。结果268例超早产儿中位胎龄27周（23周3 d-27周6 d）。随胎龄减小死亡风险呈上升趋势，胎龄25-〈26周（OR=2.659，95%CI：1.211-5.840），胎龄〈25周（OR=10.029，95%CI：3.266-30.792）。2008年1月1日至2015年12月31日超早产儿收住患儿数较1999年1月1日至2007年12月31日明显增加，且死亡风险较前9年明显下降（OR=0.490，95%CI：0.272-0.884）。经多因素非条件逐步Logistic回归分析结果显示超早产儿死亡预后影响因素是出生胎龄〈25周（OR=6.033，95%CI：1.393-26.133）、出生体重（OR=0.997，95%CI：0.995-1.000）、Ⅲ期坏死性小肠结肠炎（OR=15.907，95% CI：3.613-70.033）、Ⅰ-Ⅱ级脑室内出血（OR=0.260，95% CI：0.117-0.575）、需有创机械通气者（OR=3.630，95%CI：1.111-11.867）。结论超早产儿死亡预后影响因素中危险因素为出生胎龄〈25周、出生体重（出生体重越小死亡风险越高）、Ⅲ期坏死性小肠结肠炎、需有创机械通气者；保护因素为Ⅰ-Ⅱ级脑室内出血。

Objective To investigate the predictive factors of mortality in extremely preterm infants. Methods The retrospective case-control study was accomplished in the Second Affiliated Hospital and Yuying Children＇s Hospital of Wenzhou Medical University. A total of 268 extremely preterm infants seen from January 1, 1999 to December 31, 2015 were divided into survival group （192 cases） and death group （76 cases）. The potential predictive factors of mortality were identified by univariate analysis, and then analyzed by multivariate unconditional Logistic regression analysis. The mortality and predictive factors were also compared between two time periods, which were January 1, 1999 to December 31, 2007 （65 eases） and January 1, 2008 to December 31, 2015 （203 eases）. Results The median gestational age （GA） of extremely preterm infants was 27 weeks （23^＋3-27^＋6 weeks）. The mortality was higher in infants with GA of 25-〈26 weeks （OR=2.659, 95% Ch 1.211-5.840） and〈25 weeks （OR=10.029, 95% CI： 3.266-30.792） compared to that in infants with GA〉 26 weeks. From January 1, 2008 to December 31, 2015, the number of extremely preterm infants was increased significantly compared to the previous 9 years, while the mortality decreased significantly （OR=0.490, 95% CI： 0.272-0.884）. Multivariate unconditional Logistic regression analysis showed that GA below 25 weeks （OR=6.033, 95% CI： 1.393-26.133）, lower birth weight （OR= 0.997, 95% Ch 0.995-1.000）, stage Ⅲ necrotizing enterocolitis （NEC） （OR=15.907, 95% Ch 3.613-70.033）, grade Ⅰ and Ⅱ intraventricular hemorrhage （IVH） （OR=0.260, 95% CI： 0.117-0.575） and dependence on invasive mechanical ventilation （OR=3.630, 95% CI： 1.111-11.867） were predictive factors of mortality in extremely preterm infants. Conclusions GA below 25 weeks, lower birth weight, stage Ⅱ NEC and dependence on invasive mechanical ventilation are risk factors of mortality in extremely preterm infants. But grade Ⅰ and Ⅱ IVH is protective factor.