新生儿危重评分对出生第1天近足月及足月新生儿呼吸疾病的预测价值

Predicting value of neonatal risk score for the severity of respiratory disease in late preterm and term infants within the first 24 hours after birth

目的探讨危重新生儿急症监护的呼吸评分(ACoRN评分)及新生儿紧急生理学评分围产期补充-Ⅱ(SNAPPE-Ⅱ)评分对近足月及足月新生儿呼吸疾病严重程度的预测价值。方法回顾分析2017年6月至2018年6月出生24小时内的近足月及足月患儿的临床资料,计算ACoRN和SNAPPE-Ⅱ评分。将患儿分为呼吸异常组及非呼吸异常组,呼吸异常组再分为暂时性呼吸增快(TTN)组和其他呼吸异常组,采用logistic回归及受试者工作特征曲线(ROC)进行各组间比较。结果共纳入患儿259例,其中晚期早产儿116例(44.79%)、足月儿143例(55.21%),男146例(56.37%)、女113例(43.63%),出生胎龄(37.02±2.16)周,出生体质量(2.72±0.61)kg。TTN组89例,其他呼吸异常组33例,非呼吸异常组137例。三组间1分钟及5分钟Apgar评分、肺表面活性物质、抗生素应用、无创辅助通气、有创辅助通气、ACoRN评分和SNAPPE-Ⅱ评分的差异均有统计学意义(P<0.05)。Logistic回归分析显示,1分钟Apgar评分、住院天数、ACoRN评分及SNAPPE-Ⅱ评分与呼吸异常相关(P<0.05);ROC分析显示,ACoRN联合SNAPPE-Ⅱ评分效能最高(0.991),其次为ACoRN评分(0.972),最低为SNAPPE-Ⅱ评分(0.550)。结论ACoRN评分和SNAPPE-Ⅱ评分均为快速、简便的评估方法,两者联合对新生儿呼吸疾病严重程度具有一定的预测价值。

Objective To explore the predictive value of acute care of at-risk newborns respiratory score (ACoRN) and the score for neonatal acute physiology with perinatal extension-ⅡI (SNAPPE-Ⅱ) for the severity of respiratory diseases in the late preterm and term infants. Method A retrospective analysis was performed on the data of the late preterm and term infants within the first 24 hours after birth in the Second Department of Neonatology in Lanzhou University Second Hospital from June 2017 to June 2018. The data of ACoRN score and SNAPPE-Ⅱscore was calculated, and the infants were divided into respiratory disease group and non-respiratory disease group. The respiratory disease group was further divided into the transient tachypnea of newborn (TTN) group and the other respiratory disease groups. Univariate analysis, logistic regression and receiver operating characteristic curve (ROC) were used to analyze different groups of those infants. Results There were 89 cases in the TTN group, 33 cases in the other respiratory disease group and 137 cases in the non-respiratory disease group. The mean gestational age was (37.02±2.16) weeks, mean birth weight was (2.72±0.61) kg. Univariate analysis showed that 1 minute Apgar score, 5 minutes Apgar score, pulmonary surfactant, antibiotic treatment, non-invasive assistant ventilation, invasive assistant ventilation, ACoRN score and SNAPPE-Ⅱ score had significant differences statistically (P < 0.05). Logistic regression analysis showed that 1 minute Apgar score, length of stay, ACoRN score and SNAPPE-Ⅱ score were correlated with the respiratory disease group compared with the non-respiratory disease group (P <0.05). ROC analysis showed that the efficiency of the score of ACoRN correlated with SNAPPE-Ⅱ was the highest (AUC=0.991) than that of ACoRN (AUC=0.972) and that of SNAPPE-Ⅱ(AUC=0.550) separately. Conclusion ACoRN score and SNAPPE-Ⅱ score was based on a rapid, simple evaluation method respectively from the aspects of breathing and acute physiological characteristics. ACoRN correlated with SNAPPE-Ⅱ score was as a predictive index, benefitting to comprehensively judge for the abnormal degree of neonatal respiratory diseases and the indication of transporting to the neonatal intensive care unit.