极低出生体重新生儿的组织学绒毛膜羊膜炎与疾病严重程度
Histologic chorioamnionitis and severity of illness in very low birth weight newborns.
作者信息
De Felice Claudio, Toti Paolo, Parrini Stefano, Del Vecchio Antonio, Bagnoli Franco, Latini Giuseppe, Kopotic Robert J
机构信息
Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale M. Bracci 16, I-53100 Siena, Italy.
出版信息
Pediatr Crit Care Med. 2005 May;6(3):298-302. doi: 10.1097/01.PCC.0000160658.35437.65.
OBJECTIVE
Estimating the risk of in-hospital mortality in the neonatal intensive care unit provides important information for health care providers, and several neonatal illness severity scores have been developed. Histologic chorioamnionitis (HCA) is a known cause of neonatal morbidity and mortality. To date, the relationship between HCA and neonatal illness severity scores has not been rigorously tested. In this study, the relationships among HCA, initial illness severity, and neonatal outcomes were analyzed in very low birth weight (VLBW) newborns admitted to the neonatal intensive care unit.
DESIGN
Prospective.
SETTING
Neonatal intensive care unit.
PATIENTS
A total of 116 VLBW inborn infants (gestational age, 28.1 +/- 2.82 wks; birth weight, 1009 +/- 312 g) were categorized as HCA-positive (n = 67) and HCA-negative (n = 49).
INTERVENTIONS
Placental histology was performed to identify HCA. Illness severity evaluation included several different neonatal illness severity scores-Clinical Risk Index for Babies (CRIB), CRIB-II, Score for Neonatal Acute Physiology-II (SNAP-II), and Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPE-II)-as well as the recording of severe morbidity and in-hospital mortality.
MEASUREMENTS AND MAIN RESULTS
HCA-positive VLBW newborns showed significantly lower gestational age (p < .0001) and birth weight (p = .0010), together with higher CRIB, CRIB-II, SNAP-II, and SNAPPE-II scores at admission to the NICU (p </= .0001) and mortality rate (p = .0018) than HCA-negative infants. After adjustment for gender and gestational age in a multivariable logistic regression analysis, HCA was found to be an independent predictor of high illness severity: CRIB > 5 (odds ratio [OR], 21.37; 95% confidence interval [CI], 6.24-73.21); CRIB-II > 10 (OR, 56.17; 95% CI, 6.75-467.2); SNAP-II > 22 (OR, 43.05; 95% CI, 11.9-155.7), and SNAPPE-II > 42 (OR, 48.95; 95% CI, 10.18-235.4) (all p values <.0001).
CONCLUSIONS
Our findings indicate that HCA is a major predictor of morbidity and mortality in VLBW newborns.
目的
评估新生儿重症监护病房（NICU）内的住院死亡率风险可为医疗服务提供者提供重要信息，并且已经开发了多种新生儿疾病严重程度评分系统。组织学绒毛膜羊膜炎（HCA）是新生儿发病和死亡的已知原因。迄今为止，HCA与新生儿疾病严重程度评分之间的关系尚未得到严格检验。在本研究中，我们分析了入住NICU的极低出生体重（VLBW）新生儿中HCA、初始疾病严重程度和新生儿结局之间的关系。
设计
前瞻性研究。
地点
新生儿重症监护病房。
患者
共有116例VLBW足月儿（胎龄28.1±2.82周；出生体重1009±312克）被分为HCA阳性组（n = 67）和HCA阴性组（n = 4）。
干预措施
进行胎盘组织学检查以确定HCA。疾病严重程度评估包括几种不同的新生儿疾病严重程度评分——婴儿临床风险指数（CRIB）、CRIB-II、新生儿急性生理学评分-II（SNAP-II）和新生儿急性生理学围产期扩展评分-II（SNAPPE-II）——以及记录严重发病率和住院死亡率。
测量指标及主要结果
与HCA阴性婴儿相比，HCA阳性的VLBW新生儿胎龄（p <.0001）和出生体重（p =.0010）显著更低，入住NICU时CRIB、CRIB-II、SNAP-II和SNAPPE-II评分更高（p≤.0001），死亡率也更高（p =.0018）。在多变量逻辑回归分析中对性别和胎龄进行校正后，发现HCA是疾病严重程度高的独立预测因素：CRIB>5（比值比[OR]，21.37；95%置信区间[CI]，6.24 - 73.21）；CRIB-II>10（OR，56.17；95%CI，6.75 - 467.2）；SNAP-II>22（OR，43.05；95%CI，11.9 - 155.7），以及SNAPPE-II>42（OR，48.95；95%CI，10.18 - 235.4）（所有p值<.0001）。
结论
我们的研究结果表明，HCA是VLBW新生儿发病和死亡的主要预测因素。
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