剖宫产新生儿出生6h内发生低血糖的风险预测模型的构建

Construction of a Risk Prediction Model of Neonatal Hypoglycemia by Cesarean Section Within 6 Hours After Birth

目的构建剖宫产新生儿出生6 h内发生低血糖的风险预测模型,为早期识别经剖宫产娩出的新生儿低血糖高危人群提供依据。方法2022年1-5月,采用便利抽样法选取在某三级甲等妇幼保健专科医院剖宫产分娩的2456例新生儿为研究对象,将是否发生低血糖分为低血糖组(n=161)和非低血糖组(n=2295)。分析剖宫产新生儿出生6 h内发生低血糖的影响因素,运用Logistic回归构建模型。采用Hosmer-Lemeshow、受试者工作特征曲线下面积(area under curve,AUC)等对模型拟合优度和预测效果评价。结果两组新生儿在胎龄、低体重儿、小于胎龄儿、合并先天性心脏病、低体温、红细胞增多症、母亲糖尿病、母亲高血压、母亲术前禁食、母亲产前用药等项目上的差异均有统计学意义(均P<0.05)。早产儿、小于胎龄儿、低体温、先天性心脏病、红细胞增多症、母亲糖尿病、母亲高血压、术前禁食是剖宫产新生儿6 h内发生低血糖的8个独立危险因素。H-L检验χ^(2)为3.014,P为0.884,AUC为0.813,灵敏度为0.795,特异度为0.696,Youden指数为0.491。结论构建的模型预测效果良好,可有效预测剖宫产新生儿6h内发生低血糖的风险因素,值得推广应用。

Objective To construct a risk prediction model of neonatal hypoglycemia by Cesarean section within 6 hours after birth,so as to provide a basis for early identification of neonatal hypoglycemia high-risk population.Methods From January to May 2022,2456 newborns delivered by Cesarean section in a tertiary A women’s hospital were selected by the convivence sampling method.They were divided into hypoglycemia group(n=161)and non-hypoglycemia group(n=2295).To analyze the influencing factors of hypoglycemia in neonates delivered by Cesarean section within 6 hours after birth,and Logistic regression was used to construct a model.Hosmer-Lemeshow and area under the receiver operating characteristic curve(AUC)were used to evaluate the goodness of fit and prediction effect of the model.Results There were significant differences between the 2 groups in gestational age,low birth weight,small for gestational age(SGA),congenital heart disease,hypothermia,polycythemia,maternal diabetes,maternal hypertension,preoperative fasting,and prenatal medication(all P<0.05).There were 8 independent risk factors for neonatal hypoglycemia,including premature infant,SGA,hypothermia,congenital heart disease,polycythemia,maternal diabetes,maternal hypertension and preoperative fasting.H-L test wasχ^(2)=3.014,P=0.884,AUC was 0.813,sensitivity was 0.795,specificity was 0.696,and Youden index was 0.491.Conclusion This model has a good prediction effect,which can effectively predict the risk of neonatal hypoglycemia by Cesarean section within 6 hours after birth,and is worthy of promotion and application.