新生儿产伤发生率及高危因素的单中心研究

A single-center study of the incidence of neonatal birth trauma and its risk factors

摘要:

目的 调查单中心医疗机构产科分娩新生儿产伤的发生率，探讨新生儿发生产伤的危险因素。方法 收集2015年10月至2018年9月北京大学国际医院产科分娩的所有足月单胎新生儿及母亲的病历资料。发生新生儿产伤的为病例组，未发生产伤的作为对照组。采用多因素logistic回归分析评估新生儿产伤发生的危险因素。结果 3年内分娩的4 682名足月单胎新生儿中，新生儿产伤201例，发生率为4.29%。最常见的产伤类型是头颅血肿（81.7%），其次为面神经麻痹（9.1%）。经阴道分娩、产钳助产、催产素引产、胎膜早破、头围大是发生产伤的危险因素（分别OR=5.020、23.294、1.409、1.928、2.295，P < 0.05）。结论 新生儿产伤最常见的类型是头颅血肿。经阴道分娩、产钳助产、催产素引产、胎膜早破、新生儿头围大可能增加新生儿产伤的发生风险，其中产钳助产是最重要的独立危险因素。

Abstract:

Objective To investigate the incidence of neonatal birth trauma in the department of obstetrics in a single-center medical institution and the risk factors for neonatal birth trauma. Methods The maternal and infant medical records of all full-term singleton neonates delivered in the Department of Obstetrics, Peking University International Hospital, from October 2015 to September 2018 were collected. The neonates with birth trauma were assigned to case group, and those without birth trauma were assigned to control group. The risk factors for neonatal birth trauma were identified by multivariate logistic regression analysis. Results Of the 4 682 full-term singleton neonates delivered during the study period, 201 (4.29%) were diagnosed with birth trauma. The most frequent type of birth trauma was cephalohematoma (81.7%), followed by facial nerve palsy (9.1%). The multivariate logistic regression analysis identified vaginal delivery, forceps-assisted delivery, induction of labor by oxytocin, premature rupture of membranes and a large neonatal head circumference as the risk factors for birth trauma (OR=5.020, 23.294, 1.409, 1.928 and 2.295 respectively; P < 0.05). Conclusions The most frequent type of neonatal birth trauma is cephalohematoma. Vaginal delivery, forceps-assisted delivery, induction of labor by oxytocin, premature rupture of membranes and a large neonatal head circumference may increase the risk of neonatal birth trauma, and forceps-assisted delivery is the strongest independent risk factor for birth trauma.