极低和超低出生体质量儿发生低血糖的高危因素分析

Analysis of the risk factors of hypoglycemia in the early postnatal period of very low and extremely low birth weight infants

目的探讨极低和超低出生体质量儿生后30 min内发生低血糖的高危因素。方法回顾性分析徐州医科大学附属连云港医院2015年1月1日至2019年12月31日新生儿重症监护病房收治的体质量≤1500 g的病儿,共237例。根据新生儿生后30 min内动脉血糖值的不同,将其分为正常血糖组(对照组)167例和低血糖组(观察组)70例,并采用χ^(2)检验、Mann-Whitney U检验对新生儿及孕母一般资料、母孕期所患疾病进行单因素分析,采用二元logistic回归模型对可造成低血糖的影响因素进行多因素分析。结果两组病儿孕母一般资料及孕期所患疾病比较:妊娠期糖尿病、妊娠期高血压、产前使用糖皮质激素是极低和超低体质量儿生后30 min内发生低血糖的影响因素,差异有统计学意义(P<0.05);两组孕次、产次、前置胎盘、胎膜早破、胎盘早剥、妊娠期贫血的比较,差异无统计学意义(P>0.05)。两组新生儿一般资料比较发现,剖宫产、小于胎龄儿是造成极低和超低出生体质量儿生后30 min内发生低血糖的影响因素,差异有统计学意义(P<0.05);两组间性别、出生体质量、胎龄、胎数、Apgar评分比较,均差异无统计学意义(P>0.05)。多因素分析结果提示小于胎龄儿、妊娠期糖尿病、产前使用糖皮质激素是导致极低和超低出生体质量儿生后30 min内出现低血糖的独立危险因素,差异有统计学意义(OR=2.331,95%CI:1.103~4.927;OR=3.964,95%CI:1.400~11.222;OR=3.866,95%CI:2.044~7.311)。结论小于胎龄儿、孕母患妊娠期糖尿病、产前使用糖皮质激素的极低和超低体质量儿生后极易发生低血糖,临床医生应加强对此类病儿的监测,降低早期低血糖的发生率,以减少低血糖所造成的远期不良结局。

Objective To investigate the high risk factors of hypoglycemia in very low and extremely low birth weight infants within 30 minutes after birth.Methods Two hundred and thirty-seven children with a birth weight of≤1500 g who admitted to the neonatal intensive care unit in Lianyungang Hospital Affiliated to Xuzhou Medical University from January 1,2015 to December 31,2019 were retrospectively analyzed.Newborns were assigned into the normal blood glucose group(control group)and the hypoglycemia group(ob⁃servation group)according to their different arterial blood glucose values within 30 minutes after birth.The chi-square test and Mann Whitney U test were used to single factor analysis for the general information of the newborn and pregnant mothers,diseases of the moth⁃er during pregnancy.The multivariate analysis was performed on the influencing factors of hypoglycemia by using binary Logistic re⁃gression model.Results Comparison of general information of pregnant mothers and diseases during pregnancy between the two groups:gestational diabetes mellitus,gestational hypertension,antenatal corticosteroids were influential factors for the occurrence of hy⁃poglycemia within 30 minutes after birth of very low and extremely low birth weight infants,and the difference between the two groups was statistically significant(P<0.05).There were no statistically significant differences between the two groups in gravidity and parity history,placenta previa,premature rupture of membranes,placental abruption,and anemia during pregnancy(P>0.05).Comparison of general data of newborns between the two groups:cesarean section and small for gestational age were the influencing in the occurrence of hypoglycemia in very low and extremely low birth weight infants within 30 minutes after birth,and the difference was statistically sig⁃nificant(P<0.05).There were no statistically significant differences in gender,birth weight,gestational age,number of fetuses,and Ap⁃gar scores of 1 minute and 5 minutes between the two groups(P>0.05).Multivariate analysis results:Small gestational age,gestational diabetes mellitus,and antenatal corticosteroids were independent risk factors for very low and extremely low birth weight infants with hypoglycemia within 30 minutes after birth,and the differences were statistically significant(OR:2.331,95%CI:1.103-4.927;OR:3.964,95%CI:1.400-11.222;OR:3.866,95%CI:2.044-7.311).Conclusions Very low and extremely low birth weight infants who are small for gestational age,pregnant women suffer from gestational diabetes and use glucocorticoids before delivery are prone to have hypoglyce⁃mia after birth.Clinicians should strengthen the monitoring of such children to reduce the occurrence of early hypoglycemia,so as to re⁃duce the long-term adverse outcomes caused by hypoglycemia.