安徽省住院早产儿脑损伤多中心流行病学调查

A multicenter epidemiological investigation of brain injury in hospitalized preterm infants in Anhui, China

摘要:

目的 开展安徽省住院早产儿脑损伤多中心流行病学调查，探讨早产儿脑损伤发生的危险因素，为其早期预防和治疗提供循证依据。方法 以2016年1月至2017年1月安徽省新生儿协作网9家医院新生儿科住院早产儿为研究对象，收集早产儿母亲妊娠资料及早产儿出生资料和住院资料，采用logistic回归模型分析早产儿脑损伤发生的危险因素。结果 共纳入3 378例早产儿，脑室周围-脑室内出血（PVH-IVH）发生率为23.56%（798/3 387），脑室周围白质软化（PVL）发生率为2.60%（88/3 387）。宫内窘迫、贫血、低血糖、坏死性小肠结肠炎（NEC）为PVH-IVH发生的危险因素（OR分别为1.310、1.591、1.835、3.310，P < 0.05），较大胎龄为PVH-IVH发生的保护因素（OR为0.671，P < 0.05）。PVH-IVH、NEC和应用机械通气是PVL发生的危险因素（OR分别为4.017、3.018、2.166，P < 0.05），女性和应用肺表面活性物质是PVL的保护因素（OR分别为0.514、0.418，P < 0.05）。结论 窒息缺氧、感染/炎症、应用机械通气、贫血、低血糖等因素可增加早产儿脑损伤发生的风险。

Abstract:

Objective To investigate the risk factors for brain injury in preterm infants by a multicenter epidemiological investigation of brain injury in hospitalized preterm infants in Anhui, China. Methods Preterm infants who were hospitalized in the department of neonatology in 9 hospitals of Anhui Neonatal Collaboration Network between January 2016 and January 2017 were enrolled as subjects. The data of maternal pregnancy and clinical data of preterm infants were collected, and the logistic regression model was used to analyze the risk factors for brain injury in preterm infants. Results A total of 3 378 preterm infants were enrolled. Of the 3 378 preterm infants, 798 (23.56%) had periventricular-intraventricular hemorrhage (PVH-IVH), and 88 (2.60%) had periventricular leukomalacia (PVL). Intrauterine distress, anemia, hypoglycemia and necrotizing enterocolitis (NEC) were risk factors for PVH-IVH (OR=1.310, 1.591, 1.835, and 3.310 respectively; P < 0.05), while a higher gestational age was a protective factor against PVH-IVH (OR=0.671, P < 0.05). PVH-IVH, NEC and mechanical ventilation were risk factors for PVL (OR=4.017, 3.018, and 2.166 respectively; P < 0.05), and female sex and use of pulmonary surfactant were protective factors against PVL (OR=0.514 and 0.418 respectively; P < 0.05). Conclusions Asphyxia/anoxia, infection/inflammation, mechanical ventilation, anemia and hypoglycemia may increase the risk of brain injury in preterm infants.