入院低体温质量改进项目对胎龄≤34周早产儿近期结局的影响

The effect of the quality improvement project of admission hypothermia on short-term outcomes of preterm infants less than 34 weeks gestational age

目的研究胎龄≤34周的早产儿入院低体温的高危因素,分析入院低体温质量改进项目实施前后低体温的发生率及对各系统并发症的影响,旨在提高对低体温患儿的早期识别并揭示及时进行体温管理的重要临床意义。方法收集2017年5月至2018年12月在湖北省妇幼保健院出生,胎龄≤34周,生后1 h内收住新生儿科的早产儿临床资料。将患儿按入院体温分为正常体温组(36.5~37.5℃)、轻度低体温组(36.0~36.4℃)、中度低体温组(32.0~35.9℃)和重度低体温组(<32.0℃),分析早产儿入院低体温的高危因素,对比入院低体温质量改进项目实施前后低体温的发生率、程度及对各系统并发症的影响。结果共纳入306例早产儿,其中正常体温组63例(20.6%),轻度低体温组115例(37.6%),中度低体温组128例(41.8%),无重度低体温患儿。出生窒息患儿低体温发生风险更高(OR=0.195,95%CI 0.046-0.833,P=0.027);生后1 min(r=0.123,P=0.032)和5 min Apgar评分(r=0.136,P=0.017)越低,入院体温越低。入院低体温质量改进项目实施后,入院低体温的发生率由82.3%降至73.8%(χ^(2)=32.674,P<0.001),呼吸窘迫综合征患儿的肺表面活性物质使用率显著减少(70.0%比32.0%,χ^(2)=40.114,P<0.001),生后72 h内低血压的发生率减低(11.8%比4.9%,χ^(2)=3.867,P<0.049)。结论出生窒息是早产儿发生入院低体温的危险因素,Apgar评分与早产儿发生入院低体温相关。进行早产儿体温管理可显著减少低体温、低血压的发生率,减少呼吸窘迫综合征患儿的肺表面活性物质使用率。

Objective To study the high risk factors of hypothermia in premature infants with gestational age≤34 weeks,and to analyze the incidence of hypothermia before and after the implementation of the quality improvement program of hypothermia in hospital and its influence on various systemic complications,aiming to improve the early identification of hypothermia and to reveal the important clinical significance of temperature management in time.Methods Clinical data of preterm infants born in Maternal and Child Health Hospital of Hubei Province from May 2017 to December 2018,with gestational age≤34 weeks,and admitted within 1 hour after birth were collected.According to the admission temperature,the infants were divided into normal temperature group(36.5-37.5℃),mild hypothermia group(36.0-36.4℃),moderate hypothermia gsroup(32.0-35.9℃),and severe hypothermia group(<32.0℃).The high risk factors of hypothermia in premature infants were analyzed.The incidence and degree of hypothermia and the effects on the systemic complications before and after the implementation of the hypothermia quality improvement program were compared.Results A total of 306 premature infants were enrolled in the study,including 63(20.6%)cases in the normal temperature group,115(37.6%)cases in the mild hypothermia group,and 128(41.8%)cases in the moderate hypothermia group,without severe hypothermia.Infants with birth asphyxia were at higher risk for hypothermia(OR=0.195,95%CI 0.046-0.833,P=0.027);the lower the Apgar score at 1 min(r=0.123,P=0.032)and 5 min after birth(r=0.136,P=0.017),the higher the risk of admission hypothermia.After the quality improvement project,the incidence of admission hypothermia decreased from 82.3%to 73.8%(χ^(2)=32.67,P<0.001),and the use of pulmonary surfactant in infants with respiratory distress syndrome was significantly reduced(70.0%vs.32.0%,χ^(2)=40.11,P<0.001),and the incidence of hypotension within 72 hours after birth decreased(11.8%vs.4.9%,χ^(2)=3.87,P<0.049).Conclusion Birth asphyxia is a risk factor for admission hypothermia in premature infants,and Apgar score is associated with admission hypothermia in premature infants.Temperature management of preterm infants can significantly reduce the incidence of hypothermia and hypotension,and reduce the use of pulmonary surfactant in respiratory distress syndrome infants.