Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Front Endocrinol (Lausanne). 2022 May 12;13:823707. doi: 10.3389/fendo.2022.823707. eCollection 2022.
Many factors can affect the clinical outcome of extremely premature infants (EPIs), but the effect of sex is paradoxical. This study used propensity score matching to adjust baseline information to reassess the clinical outcome of EPIs based on sex.
A retrospective analysis was performed on EPIs admitted in the Department of Neonatology of the Third Affiliated Hospital of Guangzhou Medical University from 2011 to 2020. A propensity score matching (PSM) analysis was used to adjust the confounding factors including gestational age, birth weight, 1-minute Apgar score ≤ 3, withholding or withdrawing life-sustaining treatment(WWLST), mechanical ventilation, duration of mechanical ventilation, the mother with advanced age (≥35 years old), complete-course antenatal steroid therapy and hypertensive disorders of pregnancy. The survival rate at discharge and the incidence of major complications were evaluated between the male and female groups.
A total of 439 EPIs were included, and 240 (54.7%) infants were males. After matching the nine confounding factors, 148 pairs of infants were finally enrolled. There was no significant difference in the survival rate at discharge, as well as the mortality of activating treatment or WWLST between the two groups (all >0.05). However, the incidence of respiratory distress syndrome, bronchopulmonary dysplasia (BPD), and moderate to severe BPD in the male group was significantly increased (all <0.01), especially at birth weight between 750 and 999 grams.
The male EPIs have a higher risk of respiratory complications than females, particularly at 750 to 999 grams of birth weight.
许多因素会影响极早产儿（EPIs）的临床结局，但性别因素的影响却存在矛盾。本研究采用倾向评分匹配（PSM）调整基线信息，重新评估基于性别的 EPIs 临床结局。
对 2011 年至 2020 年广州医科大学附属第三医院新生儿科收治的 EPIs 进行回顾性分析。采用倾向评分匹配（PSM）分析调整混杂因素，包括胎龄、出生体重、1 分钟 Apgar 评分≤3 分、保留或放弃生命支持治疗（WWLST）、机械通气、机械通气时间、母亲高龄（≥35 岁）、全程产前皮质类固醇治疗和妊娠高血压疾病。评估男女组出院时的生存率和主要并发症的发生率。
共纳入 439 例 EPIs，其中男婴 240 例（54.7%）。在匹配 9 个混杂因素后，最终纳入 148 对婴儿。两组出院时生存率及激活治疗或 WWLST 死亡率差异均无统计学意义（均>0.05）。但男婴组呼吸窘迫综合征、支气管肺发育不良（BPD）和中重度 BPD 的发生率明显升高（均<0.01），尤其是出生体重在 750~999 克之间。
男婴 EPIs 的呼吸系统并发症风险高于女婴，尤其是出生体重在 750~999 克之间。
