新生儿出生头围影响因素分析

Influencing factors of head circumference in neonates

目的探讨新生儿出生头围的影响因素,为建立新生儿头围正常参考值范围样本筛选,制定小头畸形诊断标准提供科学依据。方法收集2014年1月-2017年12月广东省某医院分娩新生儿信息,对48928例活产单胎新生儿资料使用t检验/单因素方差分析和多因素广义线性回归进行统计分析。结果新生儿的平均出生头围为(33.4±1.7)cm。新生儿胎龄越大、剖宫产分娩、男性、羊水过多和产妇年龄越大、籍贯隶属北方省份、多孕、多产、合并妊娠期糖尿病导致新生儿出生头围偏大(P<0.05)。新生儿宫内生长受限、脐带绕颈、脐带扭转、羊水过少和产妇妊娠期合并高血压疾病、胆汁淤积症、贫血导致新生儿出生头围偏小(P<0.05)。新生儿结构异常、辅助生殖受孕、羊水浑浊和产妇甲状腺功能异常、瘢痕子宫、前置胎盘和生殖道感染对头围无显著影响(P>0.05)。结论新生儿出生头围影响因素众多,在制定出生头围正常参考值范围时,除了考虑生理因素的差异,还应排除有相关疾病因素的样本,如宫内生长受限、妊娠期合并症(妊娠期糖尿病、高血压疾病、胆汁淤积症、贫血)、羊水异常、脐带异常等,以确保参考值范围的科学性。

Objective To explore the influencing factors of neonatal head circumference,in order to provide basis for sample selection in reference range,and for screening microcephaly in zika virus infection. Methods A total of 48 928 cases born in Guangdong Women and Children′s Hospital were selected in this study from January 2014 to December 2017,and the clinical data were collected retrospectively.The influencing factors of head circumference at birth were analyzed by independent sample t test/variance analysis and multivariate generalized linear regression analysis. Results The average head circumference of neonates was(33.4±1.7)cm.The head circumference of male newborns,children with larger gestational age,neonates whose ancestral homes were from northern China,delivered by cesarean section and older pregnant women,children exposed to hydramnios multiple pregnancy,multiparity,gestational diabetes mellitus was larger(P<0.05).And the head circumference of children exposed to intrauterine growth restriction,umbilical cord around neck,umbilical cord torsion,oligohydramnios and gestational hypertension,cholestasis,anemia was smaller(P<0.05).There were no significant differences on head circumference among neonates with abnormal structure,assisted reproductive,amniotic fluid characteristics,maternal thyroid function,scarred uterus,placenta previa and reproductive tract infection(P>0.05). Conclusions The neonatal head circumference is influenced by many factors.When formulating the reference range of normal birth head circumference,In addition to considering the differences of physiological factors,it is supposed to exclude samples of related disease factors,such as intrauterine growth restriction,pregnancy complications(gestational diabetes mellitus,hypertension,cholestasis and anemia),abnormal amniotic fluid,umbilical cord abnormalities and so on,so that the scientificity of the reference range can be ensured.