不同强度复苏的出生体重<1 500 g早产儿临床特征分析-多中心回顾性调查

Clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation: a multicenter retrospective analysis

摘要:

目的 比较不同强度复苏的出生体重 < 1 500 g早产儿的临床特征。方法 回顾性纳入2018年1月至2019年12月江苏省20家医院新生儿重症监护室出生体重 < 1 500 g且胎龄 < 32周的早产儿，根据在产房接受的不同强度复苏措施，分为无气管插管组（n=1 184）、气管插管组（n=166）、全面心肺复苏（extensive cardiopulmonary resuscitation，ECPR）组（n=116），比较3组患儿一般情况及临床结局等差异。结果 气管插管组、ECPR组母亲剖宫产率及产前激素使用率低于无气管插管组（P < 0.05）。气管插管组及ECPR组的胎龄、出生体重均低于无气管插管组（P < 0.05）。随着复苏强度的增强，1 min和5 min Apgar评分逐渐下降（P < 0.05），1 min和5 min Apgar评分0~3分新生儿比例逐渐上升（P < 0.05）。与无气管插管组相比，气管插管组和ECPR组患儿的病死率、中-重度支气管肺发育不良和严重并发症的发生率均升高（P < 0.05）；气管插管组患儿Ⅲ~Ⅳ级颅内出血、≥Ⅲ期早产儿视网膜病变发生率升高（P < 0.05）。结论 对于出生体重 < 1 500 g早产儿，产房复苏强度高与较低的产前激素使用率、较小的胎龄及较低的出生体重有关；接受产房内气管插管、ECRP的患儿临床不良结局发生率上升。因此，加强围生期和产房复苏质量管理对改善患儿预后具有重要意义。

Abstract:

Objective To evaluate the clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation. Methods A retrospective analysis was performed for the preterm infants with a birth weight less than 1 500 g and a gestational age less than 32 weeks who were treated in the neonatal intensive care unit of 20 hospitals in Jiangsu, China from January 2018 to December 2019. According to the intensity of resuscitation in the delivery room, the infants were divided into three groups:non-tracheal intubation (n=1 184), tracheal intubation (n=166), and extensive cardiopulmonary resuscitation (ECPR; n=116). The three groups were compared in terms of general information and clinical outcomes. Results Compared with the non-tracheal intubation group, the tracheal intubation and ECPR groups had significantly lower rates of cesarean section and use of antenatal corticosteroid (P < 0.05). As the intensity of resuscitation increased, the Apgar scores at 1 minute and 5 minutes gradually decreased (P < 0.05), and the proportion of infants with Apgar scores of 0 to 3 at 1 minute and 5 minutes gradually increased (P < 0.05). Compared with the non-tracheal intubation group, the tracheal intubation and ECPR groups had significantly higher mortality rate and incidence rates of moderate-severe bronchopulmonary dysplasia and serious complications (P < 0.05). The incidence rates of grade Ⅲ-Ⅳ intracranial hemorrhage and retinopathy of prematurity (stage Ⅲ or above) in the tracheal intubation group were significantly higher than those in the non-tracheal intubation group (P < 0.05). Conclusions For preterm infants with a birth weight less than 1 500 g, the higher intensity of resuscitation in the delivery room is related to lower rate of antenatal corticosteroid therapy, lower gestational age, and lower birth weight. The infants undergoing tracheal intubation or ECRP in the delivery room have an increased incidence rate of adverse clinical outcomes. This suggests that it is important to improve the quality of perinatal management and delivery room resuscitation to improve the prognosis of the infants.