Department of Pediatrics, Jichi Medical University, Shimotsuke city, Tochigi Pref., Japan.
Medical Policy Division, Department of Health and Welfare Services, Tochigi Prefectural Office, Utsunomiya city, Tochigi Pref., Japan.
PLoS One. 2018 Jun 12;13(6):e0198518. doi: 10.1371/journal.pone.0198518. eCollection 2018.
Although late-onset circulatory collapse (LCC) is widely recognized in Japan, its etiology and the reason for center variation in its incidence remain unclear. This study's objectives were to identify the perinatal and neonatal factors related to LCC and to estimate the factors related to the center variation in the incidence of LCC.
Extremely preterm infants born between 2008 and 2012 who were registered in the database of the Neonatal Research Network, Japan were retrospectively analyzed. LCC was defined as a clinical diagnosis of LCC and the administration of steroids. We first identified the factors that were significantly related to LCC. We then examined the cause of the center variation in the incidence of LCC, using the standardized incidence ratios (SIRs) of LCC and individual factors.
The factors significantly associated with LCC included low gestational age (odds ratio [OR]: 1.13), small for date (OR: 1.43), male sex (OR: 1.26), antenatal steroid use (OR: 1.19), respiratory distress syndrome (OR: 1.25), chronic lung disease at 36 weeks (OR: 1.16), periventricular leukomalacia (PVL) (OR: 2.57), necrotizing enterocolitis (OR: 0.59), retinopathy of prematurity (ROP) (OR: 1.73), high-frequency oscillating ventilation (HFOV) use (OR: 1.31), parenteral nutrition (OR: 1.38), and red blood cell (RBC) transfusion (OR: 1.94). The SIR of LCC ranged from 0.05 to 2.94, and was positively correlated with SIRs of PVL, ROP, HFOV use and RBC transfusion.
PVL, ROP, HFOV use and RBC transfusion were found to be correlated with the center variation in the incidence of LCC.
虽然迟发性循环衰竭（LCC）在日本被广泛认识，但病因以及发病率中心差异的原因仍不清楚。本研究的目的是确定与 LCC 相关的围产期和新生儿因素，并评估与 LCC 发病率中心差异相关的因素。
回顾性分析了 2008 年至 2012 年期间在日本新生儿研究网络数据库中登记的极早产儿。LCC 定义为 LCC 的临床诊断和类固醇的使用。我们首先确定了与 LCC 显著相关的因素。然后，我们使用 LCC 和个体因素的标准化发病比（SIR）来检查 LCC 发病率中心差异的原因。
与 LCC 显著相关的因素包括低胎龄（比值比[OR]：1.13）、小于胎龄儿（OR：1.43）、男性（OR：1.26）、产前使用类固醇（OR：1.19）、呼吸窘迫综合征（OR：1.25）、36 周时慢性肺疾病（OR：1.16）、脑室周围白质软化（PVL）（OR：2.57）、坏死性小肠结肠炎（OR：0.59）、早产儿视网膜病变（ROP）（OR：1.73）、高频振荡通气（HFOV）使用（OR：1.31）、肠外营养（OR：1.38）和红细胞（RBC）输血（OR：1.94）。LCC 的 SIR 范围为 0.05 至 2.94，与 PVL、ROP、HFOV 使用和 RBC 输血的 SIR 呈正相关。
PVL、ROP、HFOV 使用和 RBC 输血与 LCC 发病率中心差异相关。
