实施新生儿早期基本保健对阴道分娩早产儿低体温及短期临床结局的影响

Effects of early essential newborn care on hypothermia and short-term outcomes in vaginally born preterm infants

目的探讨实施新生儿早期基本保健对阴道分娩早产儿生后1 h的体温及短期临床结局的影响。方法本研究为前瞻性病例对照研究。纳入2017年1月1日至12月31日在宁夏医科大学总医院产科出生,34周≤胎龄<37周,经阴道分娩并转入新生儿重症监护病房的97例早产儿作为干预组;同期于银川市妇幼保健院产科出生的103例早产儿作为对照组。干预组实施以新生儿早期基本保健为基础的处理及管理,包括生后即刻彻底擦干、即刻母婴皮肤接触30 min和延迟脐带结扎等;对照组实施常规分娩处理。采用χ2检验比较2组早产儿生后1 h时低体温、低血糖、低氧血症的发生率,采用两独立样本t检验比较2组早产儿一般情况及母亲的初乳分泌时间,采用多因素logistic回归分析早产儿发生低体温的相关影响因素。结果最终干预组96例早产儿、对照组102例早产儿纳入分析。干预组与对照组相比,早产儿生后1 h时的低体温[17.7%(17/96)与37.3%(38/102),χ2=9.418,P=0.002]、低血糖[9.4%(9/96)与19.6%(20/102),χ2=4.142,P=0.042]及低氧血症[14.6%(14/96)与28.4%(29/102),χ2=5.578,P=0.018]的发生率降低,初乳分泌时间更早[(18.3±2.4)与(31.4±3.5)min,t=32.463,P<0.001]。多因素分析显示,出生体重<2 500 g(OR=2.483,95%CI:1.731~3.234,P=0.025)、胎龄<36周(OR=1.899,95%CI:1.325~2.472,P=0.012)、产房温度为22~24 ℃(OR=2.465,95%CI:1.279~4.754,P=0.007)、无皮肤接触(OR=2.958,95%CI:1.435~4.481,P=0.023)和快速简单擦干(OR=2.467,95%CI:1.285~4.736,P=0.006)是早产儿发生低体温的危险因素。结论实施新生儿早期基本保健能降低早产儿生后1 h时低体温、低血糖、低氧血症的发生率,利于早产儿母亲尽早分泌初乳。

Objective To investigate the effects of early essential newborn care (EENC) on body temperature and short-term clinical outcomes of vaginally born preterm infants at 1 h after birth. Methods This was a prospective case-control study. A total of 97 premature infants, who were born vaginally between 34-37 weeks in the Obstetrics Department of General Hospital of Ningxia Medical University from January 1 to December 31, 2017 and admitted to the neonatal intensive care unit were enrolled as intervention group. Another 103 premature infants, who were born vaginally in the Obstetrics Department of Yinchuan Maternal and Child Health Hospital at the same period were enrolled as control group. EENC-based treatment and management were implemented to infants in the intervention group, such as thorough drying immediately, 30 min skin-to-skin contact immediately and delayed cord clamping after birth, etc., while those in the control group were managed based on routine protocol. Chi-square test was used to compare the incidence of hypothermia, hypoglycemia and hypoxemia between the two groups at 1 h after birth. The general condition and the time of colostrum secretion were compared by two independent sample t-test. Multivariate logistic regression was used to analyze the risk factors of hypothermia. Results At last, 96 participants in the intervention group and 102 in the control group were analyzed. Compared with the control group, the intervention group showed lower incidence of hypothermia [17.7%(17/96) vs 37.3%(38/102),χ2=9.418, P=0.002], hypoglycemia [9.4%(9/96) vs 19.6%(20/102),χ2=4.142, P=0.042] and hypoxemia [14.6%(14/96) vs 28.4%(29/102),χ2=5.578, P=0.018] at 1 h after birth and earlier colostrum secretion [(18.3±2.4) vs (31.4±3.5) min, t=32.463, P<0.001]. Multivariate logistic regression analysis showed that birth weight <2 500 g (OR=2.483, 95%CI: 1.731-3.234, P=0.025), gestational age<36 weeks (OR=1.899, 95%CI: 1.325-2.472, P=0.012), room temperature between 22-24 ℃ in the delivery ward (OR=2.465, 95%CI: 1.279-4.754, P=0.007), no-skin contact (OR=2.958, 95%CI: 1.435-4.481, P=0.023) and rapid and simple drying (OR=2.467, 95%CI: 1.285-4.736, P=0.006) were the risk factors for hypothermia in premature infants. Conclusions EENC can reduce the incidence of hypothermia, hypoglycemia and hypoxemia in premature infants at 1 h after birth and may be helpful for early colostrum secretion.