Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
BMC Pediatr. 2023 Jul 5;23(1):341. doi: 10.1186/s12887-023-04114-x.
Most previous studies comparing etiological studies in infants with and without periventricular-intraventricular haemorrhage (PV-IVH) concluded that younger gestational age (GA) was associated with a higher prevalence rate of PV-IVH. However, only a few studies have examined the risk factors associated with the severity of PV-IVH after removing the influence of GA. Therefore, we investigated the risk factors apart from GA for PV-IVH severity in preterm infants less than 28 weeks.
This was a retrospective case-control study of preterm infants born in West China Second Hospital with PV-IVH between 2009 and 2020. PV-IVH was defined using cranial ultrasound screening. Preterm infants were divided into no PV-IVH and PV-IVH groups, and preterm infants with PV-IVH were divided into mild and severe PV-IVH groups. Groups were matched in a 1:1 ratio using propensity score calculated from GA. Variables were collected from infant-mother pairs. A stepwise forward multivariate logistic regression model was adopted to select factors that affected PV-IVH in preterm infants.
A total of 429 preterm infants were included. The total incidence of PV-IVH in preterm infants was 55.6%, and the incidence of mild and severe PV-IVH was 28.7% and 26.9%, respectively. We matched 162 infants with no PV-IVH with 162 infants with PV-IVH. The results suggested that electrolyte disorder (OR 2.79, 95% CI: 1.34-5.77), early-onset sepsis (OR 1.76, 95% CI: 1.01-3.08), thrombocytopenia (OR 2.87, 95% CI: 1.10-7.48), invasive mechanical ventilation (OR 4.21, 95% CI: 1.86-9.55), and male sex (OR 2.16, 95% CI: 1.29-3.60) were independently associated with PV-IVH. Then, we matched 87 infants with mild PV-IVH with 87 infants with severe PV-IVH. The results suggested that electrolyte disorder (OR 2.88, 95% CI: 1.29-6.45), thrombocytopenia (OR 5.73, 95% CI: 1.91-17.14), and invasive mechanical ventilation (OR 10.54, 95% CI: 1.16-95.85) were independently associated with severity of PV-IVH.
Regardless of GA, electrolyte disorder, early-onset sepsis, thrombocytopenia, invasive mechanical ventilation, and male sex contributed to PV-IVH in preterm infants, and electrolyte disorder, thrombocytopenia, and invasive mechanical ventilation contributed to severe PV-IVH. These risk factors may combine to predict the incidence of PV-IVH in preterm infants.
大多数比较伴有和不伴有脑室周围-脑室内出血（PV-IVH）的婴儿病因研究的既往研究得出结论，胎龄（GA）越小，PV-IVH 的患病率越高。然而，只有少数研究在消除 GA 影响后，研究了与 PV-IVH 严重程度相关的危险因素。因此，我们研究了胎龄小于 28 周的早产儿除 GA 以外的与 PV-IVH 严重程度相关的危险因素。
这是一项回顾性病例对照研究，纳入了 2009 年至 2020 年在华西第二医院出生的伴有或不伴有 PV-IVH 的早产儿。PV-IVH 采用头颅超声筛查进行定义。将早产儿分为无 PV-IVH 组和 PV-IVH 组，将 PV-IVH 早产儿分为轻度和重度 PV-IVH 组。使用 GA 计算的倾向评分对每组进行 1:1 匹配。从母婴对中收集变量。采用逐步向前多元逻辑回归模型选择影响早产儿 PV-IVH 的因素。
共纳入 429 例早产儿。早产儿 PV-IVH 的总发生率为 55.6%，轻度和重度 PV-IVH 的发生率分别为 28.7%和 26.9%。我们匹配了 162 例无 PV-IVH 早产儿和 162 例 PV-IVH 早产儿。结果表明，电解质紊乱（OR 2.79，95%CI：1.34-5.77）、早发性败血症（OR 1.76，95%CI：1.01-3.08）、血小板减少症（OR 2.87，95%CI：1.10-7.48）、有创机械通气（OR 4.21，95%CI：1.86-9.55）和男性（OR 2.16，95%CI：1.29-3.60）与 PV-IVH 独立相关。然后，我们将 87 例轻度 PV-IVH 早产儿与 87 例重度 PV-IVH 早产儿进行匹配。结果表明，电解质紊乱（OR 2.88，95%CI：1.29-6.45）、血小板减少症（OR 5.73，95%CI：1.91-17.14）和有创机械通气（OR 10.54，95%CI：1.16-95.85）与 PV-IVH 严重程度独立相关。
无论 GA 如何，电解质紊乱、早发性败血症、血小板减少症、有创机械通气和男性均与早产儿 PV-IVH 相关，而电解质紊乱、血小板减少症和有创机械通气与严重 PV-IVH 相关。这些危险因素可能共同预测早产儿 PV-IVH 的发生。
