实施新生儿早期基本保健对阴道分娩早产儿脐炎的影响

Effect of early essential newborn care on omphalitis in vaginally born preterm infants

目的探讨实施新生儿早期基本保健(early essential newborn care, EENC)技术对阴道分娩早产儿发生脐炎的影响. 方法回顾性选取2017年1月至12月在宁夏医科大学总医院出生,实施EENC后转入新生儿重症监护病房的184例早产儿作为EENC组,同期在银川市妇幼保健院出生实施常规护理的161例早产儿作为对照组.采用两独立样本t检验及χ^2检验比较2组早产儿的脐带残端脱落时间、脐部完全干燥时间及脐炎的发生率,采用单因素分析及多因素logistic回归分析脐炎的危险因素. 结果EENC组早产儿轻度脐炎的发生率低于对照组[5.4%(10/184)与11.8%(19/161),χ^2=4.520],脐带残端脱落时间和脐部完全干燥时间均短于对照组[(5.5±1.5)与(8.2±1.2)d,t=4.169;(2.6±1.4)与(3.2±1.4)d,t=4.513],P值均<0.05.多因素logistic回归分析显示,早产儿胎龄≤34周(OR=1.885,95%CI:1.109~6.757,P=0.032)、早期脐带结扎(OR=3.615,95%CI:1.372~9.381,P=0.001)及脐部有包扎(OR=1.921,95%CI:1.257~11.893, P=0.035)是早产儿发生脐炎的独立危险因素. 结论EENC推荐的脐带处理方式避免了脐炎的危险因素,故有助于降低阴道分娩早产儿脐炎的发生率.

Objective To explore the influence of early essential newborn care(EENC)on the development of omphalitis in preterm infants following normal delivery.Methods A total of 184 preterm infants,admitted to General Hospital of Ningxia Medical University from January 2017 to December 2017,were retrospectively collected as EENC group.During the same period,161 preterm infants who were born in Yinchuan Maternal and Child Health Hospital were included in the control group.Preterm infants in EENC group were managed based on the clinical practice guideline of"Early Essential Newborn Care",while those in the control group underwent routine care after birth.The incidence of omphalitis between the two groups were compared using independent-samples t test and Chi-square test.Influencing factors of omphalitis were analyzed using univariate analysis and multivariate logistic regression analysis.Results The incidence of mild omphalitis was lower[5.4%(10/184)vs 11.8%(19/161),χ^2=4.520,P<0.05],and the separation and drying up time of cord stump were both earlier in the EENC group than those in the control group[(5.5±1.5)vs(8.2±1.2)d,t=4.169;(2.6±1.4)vs(3.2±1.4)d,t=4.513;both P<0.05].Logistic regression analysis showed that gestational age≤34 weeks(OR=1.885,95%CI:1.109-6.757,P=0.032),early umbilical cord clamping(OR=3.615,95%CI:1.372-9.381,P=0.001)and bandaging of the umbilical stump(OR=1.921,95%CI:1.257-11.893,P=0.035)were independent risk factors of omphalitis in preterm infants.Conclusions Umbilical cord treatment based on EENC could reduce the incidence of omphalitis by avoiding its risk factors in preterm infants following normal delivery.