Lin L, Fang M C, Jiang H, Zhu M L, Chen S Q, Lin Z L
Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Zhonghua Er Ke Za Zhi. 2018 Apr 2;56(4):274-278. doi: 10.3760/cma.j.issn.0578-1310.2018.04.007.
To investigate the predictive factors of mortality in extremely preterm infants. The retrospective case-control study was accomplished in the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University. A total of 268 extremely preterm infants seen from January 1, 1999 to December 31, 2015 were divided into survival group (192 cases) and death group (76 cases). The potential predictive factors of mortality were identified by univariate analysis, and then analyzed by multivariate unconditional Logistic regression analysis. The mortality and predictive factors were also compared between two time periods, which were January 1, 1999 to December 31, 2007 (65 cases) and January 1, 2008 to December 31, 2015 (203 cases). The median gestational age (GA) of extremely preterm infants was 27 weeks (23-27 weeks). The mortality was higher in infants with GA of 25-<26 weeks (2.659, 95% 1.211-5.840) and<25 weeks (10.029, 95% 3.266-30.792) compared to that in infants with GA> 26 weeks. From January 1, 2008 to December 31, 2015, the number of extremely preterm infants was increased significantly compared to the previous 9 years, while the mortality decreased significantly (0.490, 95% 0.272-0.884). Multivariate unconditional Logistic regression analysis showed that GA below 25 weeks (6.033, 95% 1.393-26.133), lower birth weight (0.997, 95% 0.995-1.000), stage Ⅲ necrotizing enterocolitis (NEC) (15.907, 95% 3.613-70.033), grade Ⅰ and Ⅱ intraventricular hemorrhage (IVH) (0.260, 95% 0.117-0.575) and dependence on invasive mechanical ventilation (3.630, 95% 1.111-11.867) were predictive factors of mortality in extremely preterm infants. GA below 25 weeks, lower birth weight, stage Ⅲ NEC and dependence on invasive mechanical ventilation are risk factors of mortality in extremely preterm infants. But grade ⅠandⅡ IVH is protective factor.
探讨极早产儿死亡的预测因素。在温州医科大学附属第二医院育英儿童医院开展回顾性病例对照研究。选取1999年1月1日至2015年12月31日期间收治的268例极早产儿，分为存活组（192例）和死亡组（76例）。通过单因素分析确定死亡的潜在预测因素，再进行多因素非条件Logistic回归分析。还比较了两个时间段（1999年1月1日至2007年12月31日，65例；2008年1月1日至2015年12月31日，203例）的死亡率及预测因素。极早产儿的中位胎龄（GA）为27周（23 - 27周）。GA为25 - <26周（2.659，95%可信区间1.211 - 5.840）和<25周（10.029，95%可信区间3.266 - 30.792）的婴儿死亡率高于GA>26周的婴儿。2008年1月1日至2015年12月31日，极早产儿数量较前9年显著增加，而死亡率显著下降（0.490，95%可信区间0.272 - 0.884）。多因素非条件Logistic回归分析显示，GA<25周（6.033，95%可信区间1.393 - 26.133）、低出生体重（0.997，95%可信区间0.995 - 1.000）、Ⅲ期坏死性小肠结肠炎（NEC）（15.907，95%可信区间3.613 - 70.033）、Ⅰ级和Ⅱ级脑室内出血（IVH）（0.260，95%可信区间0.117 - 0.575）以及依赖有创机械通气（3.630，95%可信区间1.111 - 11.867）是极早产儿死亡的预测因素。GA<25周、低出生体重、Ⅲ期NEC及依赖有创机械通气是极早产儿死亡的危险因素。但Ⅰ级和Ⅱ级IVH是保护因素。
