滇东南地区新生儿院前延迟就医状况及影响因素分析

Analysis of the Status and Influencing Factors of Neonatal Pre-hospital Medical Treatment Delay in Southeast of Yunnan

目的分析滇东南地区新生儿院前延迟就医状况并探讨其影响因素。方法纳入2018年10月—2020年9月期间滇东南地区某二甲医院新生儿科收治的患儿252例,采用病例回顾性分析方法,通过描述性分析、多元Logistic回归等方法分析新生儿院前延迟的特征及其影响因素。结果新生儿发生院前延迟就医共187例(74.2%),1天内就诊率为25.8%,3天内就诊率为62.3%,7天内就诊率为88.5%,平均延迟就医天数为(4.01±3.78)天。母孕期产检不规律(OR=3.725,95%CI:1.278~10.861)、新生儿住院日龄不同(新生儿日龄>7天OR=4.050,95%CI:1.767~9.283)、识别症状的类型不同(喂养OR=6.709,95%CI:1.637~27.499;新生儿特有症状OR=19.038,95%CI:5.540~65.418;感染迹象OR=12.244,95%CI:3.487~42.996)、就医前是否自行采取措施(未自行采取措施OR=0.282,95%CI:0.126~0.631)是影响新生儿院前延迟就医的因素。结论滇东南地区新生儿存在院前就医延迟现象。应加强欠发达地区母孕期保健意识、提高家长对新生儿异常症状的认知、改善家长的求医行为,以降低新生儿院前延迟就医的发生。

Objective To describe the situation of neonatal pre-hospital medical treatment delay in southeast of Yunnan and analyze its influencing factors.Methods A total of 252 neonates admitted to the secondary hospital in southeast of Yunnan from October,2018 to September,2020 were recruited by methods of retrospective analysis.Descriptive analysis,multivariate logistic regression and other statistical methods were used to analyze its characteristics and influencing factors of pre-hospital medical treatment delay.Results There were 187 cases of neonates with pre-hospital medical treatment delay.The rate of hospital visits within 1 day,3 days and 7 days was 25.8%,62.3% and 88.5%,respectively.The average time of delay was(4.01±3.78)days.Irregular antenatal examination during pregnancy(OR=3.725,95%CI:1.278-10.861),different hospitalization age of newborns(newborn>7 days OR=4.050,95%CI:1.767-9.283),different types of recognized symptoms(Feeding OR=6.709,95%CI:1.637-27.499;Neonatal specific symptoms OR=19.038,95%CI:5.540-65.418;Signs of infection OR=12.244,95%CI:3.487-42.996)and whether the parents take measures before seeking medical treatment(Not take measures before treatment OR=0.282,95%CI:0.126-0.631)had effects on pre-hospital medical treatment delay.Conclusion Neonatal pre-hospital medical treatment delay exists in southeast of Yunnan.It is necessary to strengthen maternal health care awareness during pregnancy,improve parents'perception of neonatal abnormal symptoms and improve parents'care-seeking behavior to decrease thepre-hospital medical treatment delay in less developed areas.