早产儿脑损伤的危险因素分析

The risk factors for brain injury in premature infants

目的探讨早产儿脑损伤的危险因素。方法选取2016年9月—2019年1月出生且生后就诊于大连医科大学附属第二医院新生儿重症监护病房的204例胎龄≥196 d的早产儿。将早产儿分为脑损伤组和非脑损伤组。比较两组早产儿的基本资料、胎儿期因素、新生儿期因素,比较两组产妇的产科资料。结果脑损伤组胎龄、出生体重较非脑损伤组低(P<0.05)。两组产妇有无患妊娠期高血压疾病、妊娠期糖尿病、妊娠期感染比较,差异有统计学意义(P<0.05)。两组有无未足月胎膜早破>18 h、脐带异常、多胎妊娠比较,差异有统计学意义(P<0.05)。两组有无新生儿窒息、新生儿弥散性血管内凝血(DIC)、新生儿生后感染、肺源性呼吸衰竭、机械通气及需要输血比较,差异有统计学意义(P<0.05)。脑损伤组血红蛋白、红细胞压积较非脑损伤组高,游离甲状腺素较非脑损伤组低(P<0.05)。多因素回归分析显示,胎龄<34周[OR=2.561(95%CI:1.025,6.402),P<0.05]、血红蛋白浓度偏高[OR=1.078(95%CI:1.040,1.118),P<0.05]、新生儿生后感染[OR=4.047(95%CI:1.293,12.836),P<0.05]、新生儿窒息[OR=8.385(95%CI:1.282,54.825),P<0.05]、DIC[OR=22.005(95%CI:2.220,218.163),P<0.05]、妊娠期糖尿病[OR=3.102(95%CI:1.274,7.553),P<0.05]、妊娠期感染[OR=4.401(95%CI:1.133,17.102),P<0.05]、机械通气[OR=6.979(95%CI:1.425,34.173),P<0.05]是早产儿脑损伤的危险因素。结论引起早产儿脑损伤的危险因素繁多。新生儿胎龄<34周、血红蛋白浓度偏高、感染、窒息、DIC、机械通气、妊娠期糖尿病、妊娠期感染是早产儿脑损伤的独立危险因素。其中,DIC对早产儿脑损伤影响最大。

Objective To explore the risk factors for brain injury in premature infants.Methods We selected 204 premature infants with gestational age no less than 196 days who were hospitalized in neonatal intensive care unit of The Second Hospital of Dalian Medical University from September 2016 to January 2019,and divided them into brain injury group and non-brain injury group.The demographic data,potentially-relevant factors in the fetal and neonatal period and maternal conditions of the premature infants were compared between the groups.Results The gestational age and birth weight were lower in the brain injury group compared with the non-brain injury group(P<0.05).There were differences in the presence of maternal diseases including hypertensive disorder complicating pregnancy,gestational diabetes mellitus and infections during pregnancy(P<0.05).The incidence of preterm premature rupture of membranes lasting longer than 18 hours,abnormality of umbilical cord,and multiple gestation was also different between the groups(P<0.05).Besides,the premature infants of the two groups differed in the presence of neonatal asphyxia,disseminated intravascular coagulation,infections,and respiratory failure,as well as in the needs for mechanical ventilation and blood transfusion(P<0.05).In comparison with the non-brain injury group,the levels of hemoglobin and hematocrit were higher,but free thyroxine level was lower in the brain injury group(P<0.05).Multivariate regression analysis showed that gestational age<34 weeks[OR=2.561(95%CI:1.025,6.402)],high hemoglobin concentration[OR=1.078(95%CI:1.040,1.118)],neonatal infections[OR=4.047(95%CI:1.293,12.836)],neonatal asphyxia[OR=8.385(95%CI:1.282,54.825)],neonatal disseminated intravascular coagulation[OR=22.005(95%CI:2.220,218.163)],gestational diabetes mellitus[OR=3.102(95%CI:1.274,7.553)],gestational infections[O^R=4.401(95%CI:1.133,17.10)]and mechanical ventilation requirement in neonates[OR=6.979(95%CI:1.425,34.173)]were the risk factors for brain injury in premature infants(P<0.05).Conclusions There are multiple risk factors for brain injury in premature infants,including gestational age less than 34 weeks,high hemoglobin concentration,neonatal infection,neonatal asphyxia,neonatal disseminated intravascular coagulation,needs for mechanical ventilation in neonates,gestational diabetes mellitus and gestational infections,among which neonatal disseminated intravascular coagulation has the greatest impact on brain injury.