早产儿贫血的影响因素分析

Analysis of influencing factors of anemia in preterm infants

目的了解早产儿贫血的发病率及影响因素。方法选取2018年1月至2019年12月期间长治市人民医院新生儿科收入院的生后24小时内早产儿的病例资料289例,按其是否发生贫血分为贫血组(181例)、对照组(108例);按其贫血严重程度分为轻度贫血组(116例)、中度贫血组(60例)、重度贫血组(5例),回顾性分析早产儿贫血的影响因素。结果在289例早产儿中,贫血181例,贫血发生率为62.6%,以轻度贫血为主。贫血组的胎龄(Z=-4.483)、出生体重(t=-5.938)和出生血红蛋白(Hb)(t=-10.753)均小于对照组(均P<0.05)。早产儿住院期间最低Hb水平随胎龄的增加而增高(F=26.162,P<0.05),贫血的发生率随胎龄增加而降低(χ^2=19.126,P<0.05);住院期间最低Hb水平随出生体重的增加而增高(F=22.891,P<0.05),贫血的发生率随出生体重增加而降低(χ^2=18.268,P<0.05);与孕母无贫血比较,孕母贫血早产儿的出生Hb(t=3.112)和住院期间最低Hb(t=3.233)均较低,而贫血发生率(χ^2=6.330)较高,差异均有统计学意义(均P<0.05);与孕母无子痫前期比较,孕母子痫前期早产儿的住院期间最低Hb较低(t=2.772),而贫血发生率较高(χ^2=6.103),差异均有统计学意义(均P<0.05)。经Pearson相关检验显示,出生Hb与住院期间最低Hb呈正相关,住院天数、开奶时间、黄疸持续时间、住院期间采血次数(静脉采血总次数、微量采血总次数、采血气总次数)和呼吸机使用时间与住院期间最低Hb均呈负相关(r=-0.525~0.678,均P<0.05)。多因素分析显示,住院天数是早产儿贫血的独立危险因素(OR=1.751,95%CI:1.333~2.299,P<0.05)。结论早产儿贫血发生率较高,出生胎龄越小、出生体重越低,越容易发生贫血,但晚期早产儿也是贫血高危人群。应加强产、儿科合作,严格掌握剖宫产指征,延长胎龄以减少早产儿及晚期早产儿,加强对其监护,缩短住院时间,同时加大妊娠期合并症知识的宣传力度。

Objective To understand the incidence and influencing factors of anemia in preterm infants.Methods A total of 289 preterm infants in the neonatal unit of Changzhi Peoples’Hospital within 24 hours after birth from January 2018 to December 2019 were selected and divided into the anemia group(n=181)and the control group(n=108)according to the occurrence of anemia.According to the severity of anemia,the anemia group was further divided into mild anemia group(n=116),moderate anemia group(n=60)and severe anemia group(n=5).The influencing factors of anemia in preterm infants were retrospectively analyzed.Results Among 289 preterm infants,there were 181 cases of anemia,and the incidence of anemia was 62.6%,mainly mild anemia.The gestational age(Z=-4.483),birth weight(t=-5.938)and hemoglobin(Hb)at birth(t=-10.753)of the anemia group were all lower than those of the control group(all P<0.05).The lowest Hb level during the hospitalization of preterm infants increased with the increase of gestational age(F=26.162,P<0.05),and the incidence of anemia decreased with the increase of gestational age(χ^2=19.126,P<0.05).The lowest Hb level during the hospitalization of preterm infants increased with the increase of birth weight(F=22.891,P<0.05),and the incidence of anemia decreased with the increase of birth weight(χ^2=18.268,P<0.05).Compared with pregnant women without anemia,the level of Hb at birth(t=3.112)and the lowest Hb during hospitalization(t=3.233)of preterm infants in pregnant women with anemia were both lower,while the incidence of anemia(χ^2=6.330)was higher,the differences were statistically significant(all P<0.05).Compared with pregnant women without preeclampsia,the lowest Hb during hospitalization(t=2.772)of preterm infants in pregnant women with preeclampsia was lower,while the incidence of anemia(χ^2=6.103)was higher,the differences were statistically significant(all P<0.05).Pearson correlation tests showed that Hb level at birth was positively correlated with the lowest Hb level during hospitalization,while the length of stay,the beginning time of feeding,the duration of jaundice,the times of blood collection during hospitalization(total venous blood collection times,total trace blood collection times and total blood gas collection times)and ventilator use time were all negatively correlated with the lowest Hb level during hospitalization(r=-0.525-0.678,all P<0.05).Multivariate analysis showed that the length of stay was the independent risk factor for anemia in preterm infants(OR=1.751,95%CI:1.333-2.299,P<0.05).Conclusion The incidence of anemia in preterm infants is high,the smaller gestational age and the lower birth weight,the more likely to suffer from anemia,but the late preterm infants are also at high risk of anemia.The cooperation between obstetrics and pediatrics departments should be strengthened,the cesarean section indications should be strict controlled,the gestational age should be extended to reduce the preterm infants and late preterm infants,and their monitoring and care should be strengthened to short the length of stay.At the same time,the publicity about pregnant complications knowledge should be increased.