出生顺序对双胎早产儿并发症的影响

The effect of birth order on neonatal morbidity in preterm twins

目的探讨出生顺序对双胎早产儿并发症的影响及其原因。方法选取2020年1月—2020年12月嘉兴市妇幼保健院新生儿科收治的胎龄<35周的双胎早产儿42对为研究对象,按照出生顺序分为先出生组和后出生组,配对分析比较组间基线资料、并发症发病率、呼吸支持治疗情况、Apgar评分及血清维生素水平。结果先后娩出的双胎早产儿间呼吸窘迫综合征(RDS)发病率(14.3%vs.40.0%,P<0.05)、呼吸衰竭发病率(2.4%vs.16.7%,P<0.05)、肺泡表面活性物质(PS)使用率(11.9%vs.28.6%,P<0.05)存在显著差异。后出生组的1 min、5 min及10 min Apgar评分低于先出生组,差异有统计学意义(P<0.05);而组间血清维生素A、D及E水平无显著差异。结论对胎龄<35周的双胎早产儿,后娩出者发生RDS、呼吸衰竭、使用PS的风险更高,其原因可能是与后娩出者更易窒息有关,而与新生儿本身血清维生素A、D及E水平无关。

Objective To investigate the effect of birth order on neonatal morbidity in preterm twins and its causes.Methods Forty-two pairs of preterm twins with gestational age<35 weeks admitted to the neonatal intensive care unit of Jiaxing Maternal and Child Health Care Hospital from January 2020 to December 2020 were included in the study,and were divided into the first-born and second-born groups according to birth order.The baseline data,complication incidence,respiratory support treatment,Apgar score and serum vitamin level were compared between the groups by matched-pair analysis.Results Mortality was significantly different in respiratory distress syndrome(RDS)(14.3%vs.40.0%,P<0.05),respiratory failure(2.4%vs.16.7%,P<0.05),as well as usage of pulmonary surfactant(PS)(11.9%vs.28.6%,P<0.05)among the two groups.The significantly lower Apgar scores at 1 min,5 min,and 10 min were observed in the second-born twins.However,there were no significant differences in serum vitamin A,D,and E levels between the two groups.Conclusion For preterm twins with gestational age<35 weeks,the second-born twins had increased odds of RDS,respiratory failure,and usage of PS,probably associated with greater susceptibility to asphyxia and not with the serum levels of vitamin A,D,and E.