某院近五年婴儿出生发生早产状况及预后分析

Analysis of the prevalence and prognosis of preterm infants in a hospital over the past five years

目的分析近五年来首都医科大学附属北京妇产医院早产儿发生状况及预后,为早产儿研究提供流行病学资料。方法选择2013年1月1日-2017年12月31日本院产科出生的6038例活产早产儿(胎龄<37周)为研究对象,按照自发性早产、医源性早产进行分类,并进一步根据胎龄分为极早早产儿(胎龄<28周)、早期早产儿(胎龄28~<32周)、中期早产儿(胎龄32~34周)、晚期早产儿(胎龄34~<37周),分别研究早产儿预后。结果2013-2017年本院早产儿年发生率在7.38%~8.57%之间,平均为8.03%。近五年晚期早产儿发病率呈上升趋势,到2017年达到74.25%。医源性早产病因构成排名前3位的包括:妊娠高血压疾病(978,39.96%)、前置胎盘(478,19.53%)、胎儿宫内窘迫(222,9.07%)。医源性早期早产儿重度窒息发生率高于自发性早产儿(4.1%vs.1.2%,P<0.05),出生体重低于自发性早产儿[(1338.0±264.4)gvs.(1381.8±328.0)g,P<0.05)];医源性中期早产儿出生体重低于自发性早产儿[(1843.9±341.5)vs.(1897.0±392.7)g,P<0.05)];医源性晚期早产儿住院率高于自发性早产儿(43.9%vs.38.8%,P<0.01)。结论晚期早产儿发生率呈上升趋势,相对于相应孕周范围的自发性早产儿,医源性早期早产儿重度窒息发生率更高、早期及中期早产儿出生体重偏低、晚期早产儿需要住院的比例更高,应加强医源性早产孕母妊娠期管理、重视医源性早产儿分娩后管理。

Objective To investigate the prevalence and prognosis of premature infants in Beijing Obstetrics and Gynecology Hospital,Capital Medical University over the past five years,so as to provide epidemiological data for related research. Methods The data of 6 038 live-born premature infants(gestational age< 37 weeks) born in obstetrics department from January 2013 to December 2017 were collected.And the data were analyzed according to premature labor cause(spontaneous premature and iatrogenic premature) and gestational age of delivery,including very early premature infants with gestational age <28 weeks,early premature infants with gestational age of 28-< 32 weeks,middle premature infants with gestational age of 32-<34 weeks and late premature infants with gestational age of 34-<37 weeks. Results The annual prevalence of premature infants in this hospital was 7.38% to 8.57% from 2013 to 2017,with an average rate of 8.03%.However,the proportion of late premature infants in all preterm infants has been on the rise over the past five years,reaching 74.25% by 2017.The top three causes of iatrogenic preterm birth included gestational hypertension(978,39.96%),placenta previa(478,19.53%) and fetal distress(222,9.07%).The prevalence rate of severe asphyxia in iatrogenic early preterm infants was higher(4.1% vs.1.2%,P<0.05) and birth weight was lower than that in spontaneous early preterm infants[(1 338.0±264.4)g vs.(1 381.8±328.0)g,P<0.05)].Moreover,the birth weight of iatrogenic midterm preterm infants was lower than that of spontaneous midterm preterm infants[(1 843.9±341.5)g vs.(1 897.0±392.7)g, P<0.05)],and the hospitalization rate of iatrogenic late preterm infants was higher than that of spontaneous late preterm infants(43.9% vs.38.8%,P<0.01). Conclusions The proportion of late preterm infants is on the rise.Compared with spontaneous preterm infants in the corresponding gestational weeks,iatrogenic early preterm infants are prone to have higher rate of severe asphyxia,lower birth weight of early and middle preterm infants,and higher rate of hospitalization.So it is supposed to strengthen the management of iatrogenic preterm pregnancy and pay attention to iatrogenic premature infants.