母亲产时发热伴新生儿感染的危险因素分析

Analysis of the risk factors for neonatal infection with intrapartum maternal fever

目的探讨母亲产时发热伴新生儿感染的危险因素。方法病例对照研究。纳入2016年1月1日至12月31日在复旦大学附属妇产科医院(我院)产科建卡、母亲产时发热(体温峰值≥38℃)、胎龄≥37周、单胎的新生儿,根据我院新生儿感染的诊断标准[生后12～24 h血常规WBC≥50×10~9·L^(-1)和(或)CRP≥20 mg·L^(-1),或生后24～48 h WBC≥30×10~9·L^(-1)和(或)CRP≥8 mg·L^(-1))]分为感染组和对照组,从新生儿性别,胎龄,出生体重,分娩方式,母亲体温峰值,产前血WBC数和CRP,是否硬膜外麻醉,是否合并其他感染高危因素[B族链球菌(GBS)阳性、羊水Ⅲ°或羊水异味、胎膜早破≥18 h],分析产时发热母亲新生儿感染的可能危险因素。结果 323例新生儿进入分析,感染组123例,对照组200例。Logistic多因素回归分析显示,母亲体温>38.8℃(OR=11.89,95%CI:3.21～67.12)、产前血WBC>13.1×10~9·L^(-1)(OR=6.50,95%CI:1.87～78.25)、GBS阳性(OR=7.91,95%CI:1.77～22.13),羊水Ⅲ°或羊水异味(OR=33.1,95%CI:3.34～101.56)和胎膜早破≥18 h(OR=15.12,95%CI:5.72～67.39)为母亲产时发热新生儿感染的独立危险因素。结论新生儿感染与母亲产前体温峰值、血WBC数相关。母亲产时发热且合并其他感染高危因素者,新生儿感染风险升高。硬膜外麻醉虽会引起母亲产时发热,但可能并不增加新生儿感染的风险。

Objective To investigate the risk factors for neonatal infection with intrapartum maternal fever.Methods A retrospective case-control study was conducted in neonates (gestational age ≥ 37 weeks,singleton) born in Obstetrics and Gynecology Hospital Affiliated to Fudan University (our hospital) from January 1 to December 31,2016,with maternal fever (temperature peak ≥ 38 °C).According to the diagnostic criteria for neonatal infection in our hospital [at 12 h to 24 h after birth,blood routine WBC ≥ 50 × 10^9·L^-1 and / or CRP ≥ 20 mg·L^-1,or at 24 to 48 h after birth WBC ≥ 30 × 10^9·L^-1 and / or CRP ≥ 8 mg·L^-1 )],the neonates were divided into infected group and control group.The neonatal gender,gestational age,birth weight,mode of delivery,maternal temperature peak,prenatal blood WBC count and CRP,whether epidural anesthesia,GBS positive,amniotic fluid Ⅲ° or amniotic fluid odor,premature rupture of membranes ≥ 18 h) were analyzed to investigate the risk factors for neonatal infection.Results A total of 323 neonates were included in the analysis,123 cases in the infected group and 200 cases in the control group.Logistic multivariate regression analysis showed that the mother's temperature over 38.8℃(OR= 11.89,95% CI:3.21-67.12),prenatal blood WBC>13.1×10^9·L^-1 (OR=6.50,95% CI:1.87-78.25),GBS positive (OR= 7.91,95% CI:1.77-22.13),amniotic fluid Ⅲ° or amniotic fluid odor (OR:33.1,95% CI:3.34-101.56) and premature rupture of membranes ≥ 18 h (OR=15.12,95% CI:5.72-67.39) were the independent risk factors for neonatal infection.Conclusion Neonatal infection was associated with peak prenatal temperature and prenatal blood WBC count of their mother.The rate of neonatal infection was elevated in mothers with fever and other high-risk factors.Epidural anesthesia may cause maternal fever,but may not increase the risk of neonatal infection.