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Title: [Short-term outcomes and their related risk factors of extremely preterm and extremely low birth weight infants in Guangdong province].
Author: Collaborative Study Group for Extremely Preterm and Extremely Low Birth Weight Infants.
Journal: Zhonghua Er Ke Za Zhi; 2019 Dec 02; 57(12):934-942. PubMed ID: 31795560.
Abstract:
Objective: To study the short-term outcomes and their related risk factors of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI) in Guangdong province. Methods: The neonatal and corresponding maternal medical records of 2 392 cases of EPI and ELBWI discharged from 26 tertiary hospitals in Guangdong province during 2013-2017 were collected. Chi-square test or linear-by-linear association chi-square was used to analyze the following data on an annual basis: (1) the proportion of EPI and ELBWI in all discharged infants and preterm infants; (2) the difference in survival rate of EPI and ELBWI in different regions and types of hospital; and (3) the difference in incidence of complications. A binary Logistic regression model was established to analyze the death-related risk factors. Results: From 2013 to 2017, the enrolled infants each year were 331, 418, 458, 574 and 611, respectively. Totally, there were 1 352 (56.5%) male infants. The gestational age was (27.7±1.9) weeks, and the birth weight was (919±158) g. The proportion of EPI and ELBWI in all discharged infants increased from 2013 to 2017 (χ(2)=68.636, P<0.01), and so did the proportion in all discharged preterm infants (χ(2)=73.463, P<0.01). The overall survival rate was 60.4% (1 445/2 392), which increased from 2013 to 2017 (χ(2)=11.424, P<0.01). Besides, the survival rate was higher in the Pearl River Delta region than that in the non-Pearl River Delta region (61.7% (1 325/2 146) vs. 48.8% (120/246), χ(2)=15.505, P<0.01), and also higher in women and children specialist hospitals than that in general hospitals (66.5% (702/1 056) vs. 55.6% (743/1 336), χ(2)=29.104, P<0.01). The overall incidence of complications was 89.0% (2 130/2 392) for neonatal respiratory distress syndrome (NRDS), 72.2% (1 041/1 442) for bronchopulmonary dysplasia (BPD), 40.5% (625/1 544) for retinopathy of prematurity (ROP), 12.3% (237/1 922) for necrotizing enterocolitis (NEC), 31.0% (578/1 865) for periventricular-intraventricular hemorrhage (PV-IVH), 34.1% (656/1 922) for nosocomial infection, 26.9% (625/2 327) for patent ductus arteriosus (PDA), and 4.4% (82/1 865) for periventricular leukomalacia (PVL). From 2013 to 2017, the incidence of PVL decreased (χ(2)=6.093, P=0.014), but the incidence of BPD and PDA increased (χ(2)=24.476 and 11.741, respectively, both P<0.01). Multivariate Logistic regression analysis showed that Apgar score ≤7 at 5-minute (OR=1.830, 95%CI 1.373-2.437, P<0.01), NRDS (OR=1.407, 95%CI 1.222-1.621, P<0.01), invasive assisted ventilation (OR=1.825, 95%CI 1.241-2.683, P<0.01), maternal cervical insufficiency (OR=2.044, 95%CI 1.002-4.169, P=0.049), and medical care withdrawal (OR=25.532, 95%CI 18.867-34.553, P<0.01) increased the risk of early neonatal death, while the increase in gestational age (OR=0.869, 95%CI 0.802-0.941, P<0.01), discharged from Guangzhou and Shenzhen (OR=0.606, 95%CI 0.451-0.813, P<0.01), antenatal use of steroids (OR=0.624, 95%CI 0.471-0.828, P<0.01), premature rupture of membranes (OR=0.667, 95%CI 0.466-0.955, P=0.027), and pulmonary surfactant treatment (OR=0.532, 95%CI 0.419-0.676, P<0.01) could decrease the risk. For the mortality in the late or post-neonatal period, placenta previa (OR=2.355, 95%CI 1.006-5.516, P=0.048), cervical insufficiency (OR=3.306, 95%CI 1.259-8.679, P=0.015), PV-IVH (OR=1.486, 95%CI 1.135-1.946, P<0.01), invasive assisted ventilation (OR=2.143, 95%CI 1.208-3.801, P<0.01), and medical care withdrawal (OR=286.532, 95%CI 87.840-934.661, P<0.01) increased the risk, while the increase of birthweight (OR=0.997, 95%CI 0.996-0.999, P<0.01) decreased the risk. Conclusions: The survival rate of EPI and ELBWI increases annually, but the incidence of complications is still high. Invasive assisted ventilation, medical care withdrawal and maternal cervical insufficiency are associated with mortality in both early and late neonatal or post-neonatal period. 目的： 探讨2013—2017年广东省新生儿科住院治疗的超未成熟儿（EPI）与超低出生体重儿（ELBWI）临床救治状况。 方法： 前瞻性收集广东省26家三甲医院新生儿科于2013—2017年出院的2 392例EPI与ELBWI的住院资料及其母亲的分娩资料；采用χ(2)检验或趋势χ(2)检验分析各年EPI与ELBWI在出院患儿、出院早产儿中的构成比，EPI与ELBWI在各年、各地区、各类型医院之间的存活率及各年的并发症发生率差异；构建二分类Logistic回归模型分析导致死亡的相关危险因素。 结果： 2 392例患儿在2013—2017年的数量分别为331、418、458、574和611例；其中，男1 352例（56.5%），出生胎龄（27.7±1.9）周，出生体重（919±158）g。占2013—2017年新生儿科出院患儿的构成比和在各年出院早产儿的构成比均呈逐年增加趋势（χ(2)=68.636、73.463，P均<0.01）。整体救治存活率为60.4%（1 445/2 392），2013—2017年的存活率呈逐年增加趋势（χ(2)=11.424，P<0.01）；珠三角地区的存活率高于非珠三角地区[61.7%（1 325/2 146）比48.8%（120/246），χ(2)=15.505，P<0.01]；妇儿专科医院的存活率高于综合性医院[66.5%（702/1 056）比55.6%（743/1 336），χ(2)=29.104，P<0.01]。整体并发症发生率为新生儿呼吸窘迫综合征89.0%（2 130/2 392）、支气管肺发育不良72.2%（1 041/1 442）、早产儿视网膜病变40.5%（625/1 544）、坏死性小肠结肠炎12.3%（237/1 922）、脑室周围-脑室内出血31.0%（578/1 865）、医院获得性感染34.1%（656/1 922）、动脉导管未闭26.9%（625/2 327）、脑室周围白质软化4.4%（82/1 865）；脑室周围白质软化的发生率呈逐年减少趋势（χ(2)=6.093，P=0.014），但支气管肺发育不良、动脉导管未闭的发生率呈逐年增加趋势（χ(2)=24.476、11.741，均P<0.01）。多因素Logistic回归分析显示，5 min Apgar ≤7分（OR=1.830，95%CI 1.373~2.437）、新生儿呼吸窘迫综合征（OR=1.407，95%CI 1.222~1.621）、有创辅助通气治疗（OR=1.825，95%CI 1.241~2.683）、母亲患宫颈机能不全（OR=2.044，95%CI 1.002~4.169）、放弃积极治疗（OR=25.532，95%CI 18.867~34.553）导致早期新生儿死亡的风险增加（P均<0.05），而出生胎龄的增加（OR=0.869，95%CI 0.802~0.941）、广深地区出院（OR=0.606，95%CI 0.451~0.813）、产前使用糖皮质激素（OR=0.624，95%CI 0.471~0.828）、胎膜早破（OR=0.667，95%CI 0.466~0.955）、使用肺表面活性物质（OR=0.532，95%CI 0.419~0.676）可以降低其风险（P均<0.05）；前置胎盘或胎盘前置状态（OR=2.355，95%CI 1.006~5.516）、宫颈机能不全（OR=3.306，95%CI 1.259~8.679）、脑室周围-脑室内出血（OR=1.486，95%CI 1.135~1.946）、有创辅助通气治疗（OR=2.143，95%CI 1.208~3.801）、放弃积极治疗（OR=286.532，95%CI 87.840~934.661）导致晚期新生儿和新生儿期后死亡的风险增加，而出生体重的增加（OR=0.997，95%CI 0.996~0.999）可以降低其风险（P均<0.05）。 结论： 进入新生儿科救治的EPI与ELBWI在逐年增加，存活率逐年提高，住院并发症发生率仍高，有创辅助通气治疗、放弃积极治疗和母亲患宫颈机能不全是导致早期新生儿和晚期新生儿（或新生儿期后）死亡的共同危险因素。.

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