新生儿转诊评分预测转诊早产低出生体重儿死亡风险的比较

Comparison of referral neonatal scores in predicting the risk of death in premature and low birth weight infants

目的探讨3种新生儿转诊评分对转诊早产低出生体重儿死亡风险评估的价值.方法对2016年1月1日至2016年12月31日转诊至湖南省儿童医院新生儿科的649例胎龄<37周及出生体重<2 500g的早产低出生体重儿进行新生儿转运稳定生理指数( transport risk index of physiologic stability,TRIPS)、新生儿转运死亡指数(mortality index for neonatal transportation score,MINT)及转运相关死亡评分(transport related mortality score,TREMS).结果死亡组中TRIPS、MINT、TREMS评分明显高于生存组(P<0.001).多因素Logistic回归分析显示,TRIPS中收缩压、弹足底反应、呼吸中的气管插管进入回归方程,MINT中出生体重、血pH值、打电话时是否气管插管进入回归方程,TREMS中低血压、低氧血症、高碳酸血症进入回归方程,这表明上述指标为早产低出生体重儿发生死亡的独立危险因素.TRIPS、MINT及TREMS在预测早产低出生体重儿死亡风险时ROC曲线下面积及95%CI分别为0.843(0.796,0.889)、0.796(0.722,0.871)和0.712(0.639,0.786).结论 TRIPS评分较MINT评分和TREMS评分对转诊早产低出生体重儿的转诊死亡风险预测准确性更高.

Objective To compare the value of three neonatal referal scoring systems in predicting the risk of mortality in preterm and low birth weight infants.Methods Six hundred and fourty-nine premature neonates-fetal age <37 weeks and birth weight <2 500g infants were transported to the neonatal intensive care unit of Hunan Children′s Hospital from January 1 to December 31, 2016.The score of transport risk index of physiologic stability(TRIPS), mortality index for neonatal transportation(MINT)score and transport related mortality score(TREMS)were conducted for them.Results TRIPS, MINT and TREMS scoring systems of the death group were significantly higher than those of the survival group(P<0.001).In the multivariate Logistic regression analysis, systolic blood pressure, reaction of foot hit and the intubation of respiratory in the TRIPS entered the regression equation.The birth weight, blood pH value and whether intubation when contacted in the MINT score were included in the equation.Hypotension, hypoxemia and hypercapnia of TREMS were entered the regression equation, indicating these factors were the independent risk factors for death in preterm and low birth weight infants.The area under the receiver operating characteristic and 95%CI of TRIPS, MINT and TREMS were 0.843(0.796, 0.889), 0.796(0.722, 0.871)and 0.712(0.639, 0.786), respectively.Conclusion The TRIPS is more accurate than MINT and TREMS in predicting the risk of referral mortality in referaling preterm and low birth weight infants.