胎龄≤32周早产儿低血糖的危险因素分析

Risk factors for hypoglycemia in preterm infants with a gestational age of ≤32 weeks

摘要:

目的 探讨胎龄≤32周早产儿出生后发生低血糖的危险因素。方法 回顾性纳入2017年1月至2020年6月入住新生儿重症监护病房的86例胎龄≤32周低血糖早产儿作为低血糖组，随机选取同期住院监测血糖正常的早产儿172例为对照组。采用单因素分析与多因素logistic回归分析筛选早产儿低血糖的危险因素。结果 研究期间早产儿共计515例，其中低血糖86例（16.7%）。低血糖组小于胎龄儿（SGA）、剖宫产出生、孕母高血压、产前使用激素的比例均高于对照组（P < 0.05），而出生体重及血糖检测前已静脉使用葡萄糖的比例均低于对照组（P < 0.05）。SGA（OR=4.311，95% CI：1.285~14.462）、孕母高血压（OR=2.469，95% CI：1.310~4.652）和产前使用激素（OR=6.337，95% CI：1.430~28.095）为早产儿低血糖的危险因素（P < 0.05），静脉使用葡萄糖（OR=0.318，95% CI：0.171~0.591）为早产儿低血糖的保护因素（P < 0.05）。结论 SGA、孕母高血压和产前使用激素可增加胎龄≤32周早产儿早期发生低血糖的风险；对胎龄≤32周早产儿，建议生后尽早静脉使用葡萄糖，以减少低血糖的发生。

Abstract:

Objective To investigate the risk factors for hypoglycemia after birth in preterm infants with a gestational age of ≤ 32 weeks. Methods A retrospective analysis was performed for 86 neonates with hypoglycemia and a gestational age of ≤ 32 weeks who were admitted to the neonatal intensive care unit from January 2017 to June 2020 (hypoglycemia group). A total of 172 preterm infants with normal blood glucose who were hospitalized during the same period were randomly enrolled as the control group. Univariate analysis and multivariate logistic regression analysis were used to screen out the risk factors for hypoglycemia in preterm infants. Results There were 515 preterm infants during the study, among whom 86 (16.7%) had hypoglycemia. Compared with the control group, the hypoglycemia group had significantly higher percentages of small for gestational age (SGA), cesarean section, maternal hypertension, and antenatal steroid administration (P < 0.05), but significantly lower birth weight and rate of intravenous glucose use before blood glucose test (P < 0.05). SGA (OR=4.311, 95% CI:1.285-14.462, P < 0.05), maternal hypertension (OR=2.469, 95% CI:1.310-4.652, P < 0.05), and antenatal steroid administration (OR=6.337, 95% CI:1.430-28.095, P < 0.05) were risk factors for hypoglycemia in preterm infants, while intravenous glucose use (OR=0.318, 95% CI:0.171-0.591, P < 0.05) was a protective factor against hypoglycemia in preterm infants. Conclusions SGA, maternal hypertension, and antenatal steroid administration may increase the risk of early hypoglycemia in preterm infants with a gestational age of ≤ 32 weeks, and intravenous glucose use is recommended as soon as possible after birth for preterm infants with a gestational age of ≤ 32 weeks to reduce the incidence rate of hypoglycemia.