河南省小于胎龄儿临床特征的多中心研究

Multi-center Study on the Clinical Characteristics of Small for Gestational Age Infants in Henan Province

目的分析河南省小于胎龄儿(SGA)的临床特征,为SGA的防治提供理论支持。方法选取2019年1月1日至12月31日在河南省17地市53家医院产科分娩的<37周早产儿为研究对象,收集其一般情况、母亲社会学资料、围生期情况、并发症、结局和死亡原因等临床资料。按胎龄和出生体质量的关系分为SGA组和适于胎龄儿(AGA)组,并比较两组相关资料。结果河南省早产儿SGA发生率为12.35%;SGA组与AGA组存在体质量分布差异(P<0.05);与AGA组相比,SGA组母亲<20岁和>35岁、受教育程度初中及以下、受孕方式为人工授精和试管婴儿、妊娠1次、剖宫产和产钳助产/胎头吸引、产前糖皮质激素规范使用占比较大,母亲20~35岁、受教育程度硕士及以上、自然受孕、妊娠≥2次、自然分娩、产前不规范和未使用糖皮质激素占比较小。SGA组医源性早产原因为妊娠期高血压疾病、胎儿宫内窘迫和前置胎盘/胎盘早剥占比较大,自发性早产、胎膜早破性早产和医源性早产原因为妊娠糖尿病占比较小,肺炎、窒息、呼吸窘迫综合征、败血症、坏死性小肠结肠炎、支气管肺发育不良、脑室内出血、脑室旁白质软化、肺出血、胎粪吸入综合征发生率较高,好转率较低,放弃率、病死率、转院率较高(P<0.05)。结论河南省早产儿SGA发生率相对较低。与AGA相比,SGA危险因素较多,早产原因多为医源性,非自然分娩较多,并发症发生率较高,结局较差。

Objective Analyze the clinical characteristics of small for gestational age infants(SGA)in Henan Province,and provide theoretical support for the prevention and treatment of SGA.Methods Premature infants less than 37 weeks delivered in 53 hospitals in 17 prefectures and cities in Henan Province from January 1 to December 31,2019 were selected as the research objects,and collected clinical data such as general conditions,sociological data of mothers,perinatal conditions,complications,outcomes and causes of death.According to the relationship between gestational age and birth weight,they were divided into SGA group and appropriate for gestational age(AGA)group,and compared related information of two groups.Results The incidence of SGA in premature infants in Henan Province was 12.35%.There was difference in weight distribution between SGA group and AGA group(P<0.05).Compared with AGA group,mothers in SGA group<20 years old and>35 years old,junior high school education and below,conception methods were artificial insemination and test tube baby,1 pregnancy,cesarean section and forceps assisted delivery/fetal head suction,the standardized use of antenatal glucocorticoids accounted for a relatively large proportion,and mothers aged 20 to 35,with a master’s degree or above,natural conception,pregnancy≥2 times,natural childbirth,antenatal irregularities and no use of glucocorticoids accounted for a relatively small proportion.In SGA group,the cause of iatrogenic preterm delivery was hypertensive disorder complicating pregnancy,fetal distress and placenta previa/placental abruption accounted for a relatively large proportion,and spontaneous preterm delivery,premature rupture of membranes and the cause of iatrogenic preterm delivery was gestational diabetes mellitus accounted for a relatively small proportion,and the incidence of pneumonia,asphyxia,respiratory distress syndrome,sepsis,necrotizing enterocolitis,bronchopulmonary dysplasia,intraventricular hemorrhage,periventricular leukomalacia,pulmonary hemorrhage and meconium aspiration syndrome were relatively high,the improvement rate was relatively low,and the abandonment rate,mortality rate and transfer rate were relatively high(P<0.05).Conclusion The incidence of SGA in premature infants in Henan Province is relatively low.Compared with AGA,SGA has more risk factors,premature delivery is mostly iatrogenic,unnatural delivery is more frequent,the complication rate is higher,and the outcome is worse.