新生儿缺血缺氧性脑病合并吞咽障碍患儿试喂呛咳风险预测模型的构建

Development of a Risk Prediction Model of Trial Feeding Choking in Neonates with Hypoxic-Ischemic Encephalopathy and Dysphagia

目的分析新生儿缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)合并吞咽障碍患儿试喂呛咳的影响因素,构建列线图预测模型并验证。方法回顾性分析2019年1月至2023年6月某院新生儿科收治的HIE合并吞咽障碍患儿277例的临床资料,根据是否发生呛咳分组,对两组临床资料进行单因素分析、多因素Logistic回归分析,筛选试喂呛咳的独立危险因素,构建列线图预测模型并验证。结果Logistic回归分析结果表明,胎龄、出生体质量、HIE分度、持续正压通气、支持策略、母亲焦虑情绪、吸吮障碍评分、早期喂养能力评估总分是HIE合并吞咽障碍患儿试喂呛咳的独立危险因素(均P<0.05)。建模集和验证集AUC分别为0.956,0.961,2组Calibration校准曲线均接近于理想曲线,列线图DCA曲线图示模型具有较高的净获益值。结论基于HIE合并吞咽障碍患儿试喂呛咳发生风险因素构建的列线图预测模型,可为患儿试喂呛咳的防治提供重要指导策略。

Objective To analyze the influencing factors of trial feeding choking in neonates with hypoxic-ischemic encephalopathy(HIE)and dysphagia,and to develop and evaluate a risk prediction nomograph model.Methods The clinical data of 277 children with HIE and dysphagia admitted to the Neonatology Department of a hospital from January 2019 to June 2023 were retrospectively analyzed.According to the occurrence of coughing choking,the patients were divided into 2 groups.The clinical data were analyzed by univariate analysis and multivariate Logistic regression analysis,and independent risk factors of coughing were screened.A nomogram prediction model developed and verified.Results The results of logistic regression showed that gestational age,birth weight,HIE grading,continuous airway positive pressure ventilation,support strategies,mothers anxiety,sucking disorder score,and EFS total score were the independent risk factors of trial feeding choking in neonates with hypoxic-ischemic encephalopathy and dysphagia(P<0.05).The areas under receiver operating characteristic curve of modeling and validation set were 0.956 and 0.961 respectively.The correction of the 2 calibration groups were both close to ideal curves.The DCA curve diagram model was of a high net benefit value.Conclusions The risk prediction nomograph model established on those independent influencing factors of trial feeding choking in neonates with hypoxic-ischemic encephalopathy can provide important guidance for trial feeding choking prevention and treatment among those neonates.