胎膜早破极早产儿的临床特征和主要不良结局的预测因素分析

Clinical features of very preterm infants with prelabor rupture of membranes and predictive factors for major adverse outcomes

摘要:

目的 探讨胎膜早破（prelabor rupture of membranes，PROM）极早产儿的临床特征及其发生早发型败血症（early-onset sepsis，EOS）和死亡的预测因素。方法 回顾性收集2018年1月至2020年5月入住新生儿重症监护室的PROM极早产儿（胎龄 < 32周）的临床资料。根据胎膜破裂至分娩的时间不同分为4组：PROM < 18 h（107例）、PROM 18 h~ < 3 d（111例）、PROM 3 d~ < 14 d（144例）和PROM ≥14 d（37例）；根据是否发生EOS分为EOS组（42例）和非EOS组（357例）；根据是否存活分为存活组（359例）和死亡组（40例）。分析不同PROM时间极早产儿的临床特征，并采用多因素logistic回归分析PROM极早产儿发生EOS和死亡的预测因素。结果 不同PROM时间极早产儿新生儿期主要并发症发生率和病死率差异无统计学意义（P > 0.05）。出生体重 < 1 000 g（OR=4.353，P=0.042）、Ⅲ度羊水污染（OR=4.132，P=0.032）及Ⅲ~Ⅳ级呼吸窘迫综合征（OR=2.528，P=0.021）是PROM极早产儿发生EOS的预测因素。较低的出生体重（< 1 000 g或1 000~1 499 g；OR分别为11.267、3.456，P分别为0.004、0.050）、Ⅲ~Ⅳ级呼吸窘迫综合征（OR=5.572，P < 0.001）和新生儿败血症（OR=2.631，P=0.012）是PROM极早产儿死亡的预测因素。结论 PROM时间延长不增加极早产儿新生儿期并发症的发生率和病死率。PROM极早产儿的主要不良结局与较低的出生体重、肺发育不成熟和全身感染密切相关。

Abstract:

Objective To study the clinical features of very preterm infants with prelabor rupture of membranes (PROM) and predictive factors for early-onset sepsis (EOS) and death. Methods A retrospective analysis was performed for the clinical data of the very preterm infants with PROM (with a gestational age of < 32 weeks) who were admitted to the neonatal intensive care unit from January 2018 to May 2020. According to the time from membrane rupture to delivery, the infants were divided into four groups: < 18 hours (n=107), 18 hours to < 3 days (n=111), 3 days to < 14 days (n=144), and ≥ 14 days (n=37). According to the presence or absence of EOS, the infants were divided into EOS (n=42) and non-EOS groups (n=357). According to the survival state, the infants were divided into a survival group (n=359) and a death group (n=40). Clinical features were analyzed for very preterm infants with different times of PROM. A multivariate logistic regression analysis was used to investigate the predictive factors for EOS and death in very preterm infants with PROM. Results There was no significant difference in the incidence rates of major neonatal complications and mortality rate among the very preterm infants with different times of PROM (P > 0.05). Birth weight < 1 000 g (OR=4.353, P=0.042), grade Ⅲ amniotic fluid contamination (OR=4.132, P=0.032), and grade Ⅲ-Ⅳ respiratory distress syndrome (RDS) (OR=2.528, P=0.021) were predictive factors for EOS in very preterm infants with PROM. Lower birth weights (< 1 000 g or 1 000-1 499 g; OR=11.267 and 3.456 respectively; P=0.004 and 0.050 respectively), grade Ⅲ-Ⅳ RDS (OR=5.572, P < 0.001), and neonatal sepsis (OR=2.631, P=0.012) were predictive factors for death in very preterm infants with PROM. Conclusions Prolonged PROM does not increase the incidence of neonatal complications and mortality in very preterm infants. Adverse outcomes of very preterm infants with PROM are mainly associated with lower birth weights, lung immaturity, and systemic infection.