转运新生儿病情危重程度的影响因素研究

Application of neonatal critical illness score in neonatal transport

目的分析北京市某三级甲等儿童专科医院危重新生儿转运现状,并探讨转运新生儿病情危重程度的影响因素,为进一步完善危重新生儿转运网络管理、合理配置卫生资源、降低区域内新生儿病死率提供理论依据。方法对北京市某三级甲等儿童专科医院2018年11月—2021年12月接收的1172例转运新生儿数据进行回顾性分析,以新生儿危重病例评分(NCIS)作为判断新生儿病情危重程度的依据,应用Logistic回归分析转运新生儿病情危重程度的影响因素,并采用受试者工作特征曲线(ROC)评估该模型预测价值。结果转诊的新生儿疾病前四位依次是早产低出生体质量、新生儿败血症、呼吸衰竭、新生儿湿肺。多因素Logistic回归分析显示:早产儿、日龄≤7 d、转诊前血糖高、转运时长≥2 h、母亲产前应用激素、男性、转诊前血氧饱和度低与新生儿的危重程度有关。将回归结果绘制成ROC曲线,曲线下面积(AUC)为0.750,模型灵敏度为0.710,特异度为0.666。结论转运患儿疾病构成谱相对稳定;早产、性别(男性)、日龄≤7 d、转诊前血糖高、转诊前血氧饱和度低、转运时长≥2 h、母亲产前应用激素是新生儿发生危重情况的危险因素。医护人员应重视以上危险因素,及早做好抢救准备,提高救治能力,同时完善各级转运救治网络,合理配置卫生资源,降低新生儿病死率。

Objective To analyze the transfer status of critically ill newborns in a third-class A children's hospital in Beijing,and to explore the influencing factors of the severity of the transferred newborns,so as to provide theoretical basis for rational allocation of health resources and improvement of clinical treatment ability.Methods A retrospective analysis was conducted on the data of 1172 transshipped newborns received from a third-grade Grade-A children's hospital in Beijing from November 2018 to December 2021.Using neonatal critical illness score(NCIS)as the basis to judge neonatal criticality,Logistic regression was used to analyze the influencing factors of neonatal criticality.Receiver Operating Characteristic Curve(ROC)was used to evaluate the predictive value of the model.Results The top four referred neonatal diseases were preterm low birth weight,neonatal sepsis,respiratory failure,neonatal wet lung,in order.Multivariate Logistic regression analysis showed that:premature birth,age≤7 days,high blood glucose before referral,transfer duration≥2 hours,prenatal use of hormones,gender(female)and high oxygen saturation before referral were related to the severity of neonates.The regression results were plotted as ROC Curve,the Area Under Curve(AUC)was 0.750,the model sensitivity was 0.710,and the specificity was 0.666.Conclusion The disease spectrum of children with transport is relatively stable.Preterm birth,gender(male),age≤7 days,high blood glucose before referral,low oxygen saturation before referral,transfer duration≥2 hours,and prenatal use of hormones are risk factors for critical neonatal conditions.Medical staff should pay attention to the above risk factors,make early rescue preparations,improve treatment ability,improve the transport and treatment network at all levels,and rationally allocate health resources to reduce neonatal mortality.