不同胎龄新生儿胎粪吸入综合征的临床特征及神经损伤和死亡的危险因素：一项9年队列研究
Clinical characteristics of meconium aspiration syndrome in neonates with different gestational ages and the risk factors for neurological injury and death: A 9-year cohort study.
作者信息
Luo Lei, Zhang Meng, Tang Jun, Li Wenxing, He Yang, Qu Yi, Mu Dezhi
机构信息
Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
出版信息
Front Pediatr. 2023 Mar 7;11:1110891. doi: 10.3389/fped.2023.1110891. eCollection 2023.
BACKGROUND
The presence of meconium is associated with gestational age, and the incidence of meconium aspiration syndrome (MAS) increases with gestational age. Our study compared the differences in the clinical characteristics of patients with MAS at different gestational ages and discussed the risk factors for neurological injury and death from MAS.
METHODS
A total of 294 neonates diagnosed with MAS between 2013 and 2021 were included. Patients were divided into preterm, early-term, full-term, and late-term groups according to gestational age. We compared the patients' basic demographic, treatment, complications, and clinical outcomes in the different groups. We also analyzed the risk factors of neurological injury and death in patients with MAS.
RESULTS
The mean age at admission (0.55 ± 0.9 h) was lower and the proportion of cesarean deliveries (90.00%, 27/30) was higher in the preterm group than in the other three groups. There was no statistically significant difference among the four groups regarding 1- and 5-min Apgar scores and the need for delivery room resuscitation. In terms of complications, early-term infants had the highest incidence of neurological injury (52.9%, 27/51), and late-term infants had the highest incidence of pneumothorax (37.8%, 17/45). The overall mortality rate of children with MAS was 7.80% (23/294), and the difference in mortality rates among the four groups was not significant. Low 1-min Apgar score and gestational age, metabolic acidosis, and respiratory failure were independent risk factors for neurological injury; metabolic acidosis, respiratory failure, and sepsis were independent risk factors for death in neonates with MAS.
CONCLUSION
The clinical characteristics of MAS neonates of different gestational age are different mainly in complications. Early-term infants are more likely to complicate with neurological injury, and late-term infants are more likely to complicate with pneumothorax. Low 1-min Apgar score and gestational age, metabolic acidosis, and respiratory failure were established as risk factors for neurological injury; metabolic acidosis, respiratory failure, and sepsis were independent risk factors for death in neonates with MAS.
背景
胎粪的存在与孕周相关，胎粪吸入综合征（MAS）的发病率随孕周增加而升高。我们的研究比较了不同孕周MAS患者的临床特征差异，并探讨了MAS导致神经损伤和死亡的危险因素。
方法
纳入2013年至2021年间共294例诊断为MAS的新生儿。根据孕周将患者分为早产、早期足月、足月和晚期足月组。我们比较了不同组患者的基本人口统计学特征、治疗情况、并发症及临床结局。我们还分析了MAS患者神经损伤和死亡的危险因素。
结果
早产组的平均入院年龄（0.55±0.9小时）低于其他三组，剖宫产比例（90.00%，27/30）高于其他三组。四组在1分钟和5分钟阿氏评分及产房复苏需求方面无统计学显著差异。在并发症方面，早期足月婴儿神经损伤发生率最高（52.9%，27/51），晚期足月婴儿气胸发生率最高（37.8%，17/45）。MAS患儿的总体死亡率为7.80%（23/294），四组死亡率差异无统计学意义。1分钟阿氏评分低、孕周、代谢性酸中毒和呼吸衰竭是神经损伤的独立危险因素；代谢性酸中毒、呼吸衰竭和败血症是MAS新生儿死亡的独立危险因素。
结论
不同孕周的MAS新生儿临床特征主要在并发症方面存在差异。早期足月婴儿更易并发神经损伤，晚期足月婴儿更易并发气胸。1分钟阿氏评分低、孕周、代谢性酸中毒和呼吸衰竭被确定为神经损伤的危险因素；代谢性酸中毒、呼吸衰竭和败血症是MAS新生儿死亡的独立危险因素。
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