极低和超低出生体重儿需要复苏的危险因素分析

摘要

目的 探讨极低出生体重儿(VLBWI)和超低出生体重儿(ELBWI)需要复苏的高危因素.方法 选取产科出生的VLBWI和ELBWI 149例,根据复苏程序的不同,分为A级(无需复苏)、B级(初步复苏+常压给氧)、C级(初步复苏+气囊面罩正压通气)、D级(初步复苏+正压通气+气管插管)、E级(初步复苏+正压通气+气管插管+胸外按压+肾上腺素),用有序多分类logistic回归模型对新生儿复苏的各种因素进行分析.结果 单因素分析显示:胎龄小、出生体重低、臀位分娩、绒毛膜羊膜炎、羊水过少及孕母患系统性红斑狼疮(SLE)增加复苏的风险;剖宫产可减少复苏的风险.将上述单因素分析有统计学意义(P<0.05)的因素纳入多因素分析,胎龄、出生体重、臀位分娩、羊水过少及孕母为SLE患者被选入模型.胎龄＜30周的复苏风险是胎龄≥30周的2.19倍,ELBWI是VLBWI的2.49倍,孕母为SLE患者是非SLE患者的15.99倍,臀位分娩是正常胎位分娩的2.71倍,羊水过少为羊水量正常者的2.92倍.结论 胎龄小、出生体重低、臀位分娩、羊水过少及孕母为SLE患者是VLBWI和ELBWI需要复苏的主要危险因素,对具有以上高危情况的早产儿应及时做好新生儿复苏及抢救准备.%Objective To evaluate the risk factors of resuscitation in very low birth weight infants ( VLBWI ) and extremely low birth weight infants ( ELBWI ). Methods A total of 149 VLBWI and ELBWI were retrospectively analyzed. Ordinal logistic regression model was used in this study. According to the degree of resuscitation, the infants were divided into 5 groups: Group A ( infants who required no resuscitation ), Group B ( infants who required initial steps in stabilization and normal pressure oxygen inhalation ), Group C [ infants who required resuscitation with positive pressure ventilation ( PPV ) via face mask ], Group D ( infants who required resuscitation with PPV and endotracheal intubation ), and Group E ( infants who required resuscitation with epinephrine along with continued PPV and chest compression ). Results According to single factor test, the low gestational age, low birth weight, chorioamnionitis, oligohydramnios, breech presentation and maternal systemic lupus erythematosus ( SLE ) increased the risk of resuscitation, while cesarean section was a protective factor. According to ordinal logistic regression model, the risk of resuscitation in infants with gestational age lower than 30 weeks was 2. 19 times higher than the older ones; in ELBWI was 2. 49 times higher than in VLBWI; in those with maternal SLE was 15. 99 times higher; in those with breech presentation was 2. 71 times higher; in those with oligohydramnios was 2. 92 times higher. Conclusion Low gestational age, low birth weight, oligohydramnios, breech presentation and maternal SLE are risk factors of resuscitation, required further preparation for resuscitation.