目的探讨极低出生体重儿(VLBWI)发生肺出血的高危因素并建立预测模型。方法回顾性分析2016年10月至2023年10月安徽医科大学第一附属医院收治的142例VLBWI的临床资料,按照新生儿肺出血诊断标准分为肺出血组(63例)和无肺出血组(79例)。收集两组临床特征、凝血指标、血气分析指标等,先进行单因素分析,再纳入多因素logistic回归分析高危因素,构建预测模型,通过受试者工作特征(ROC)曲线、校准曲线及决策曲线对VLBWI肺出血预测模型进行评估。结果肺出血组和无肺出血组性别、剖宫产、羊水量异常、羊水污染、胎盘异常、脐带异常、人工授精、气管插管等比较,差异无统计学意义(P>0.05);两组出生体重、胎龄、肺表面活性物质(PS)使用、胎膜早破>18 h、产前糖皮质激素使用、低白蛋白血症、1 min Apgar评分、5 min Apgar评分、凝血酶原时间、凝血酶原活动度、国际标准化比值、活化部分凝血活酶时间(APTT)、纤维蛋白原、二氧化碳分压、HCO^(3-)、二氧化碳总量、游离钙(i Ca)比较,差异均有统计学意义(P<0.05)。多因素logistic分析显示,产前糖皮质激素使用、iCa是VLBWI肺出血发生的保护因素,PS使用、APTT是VLBWI肺出血发生的独立危险因素(P<0.05)。4个独立因素纳入最终模型,该模型的ROC曲线下面积为0.811。结论VLBWI肺出血的发生与产妇产前糖皮质激素使用、新生儿出生后PS使用、APTT延长及低iCa相关,利用这些因素构建的预测模型可帮助临床医生早期识别肺出血高危人群,为临床诊疗提供重要的参考信息,对发生肺出血有一定的预测作用。
目的分析极低出生体重儿发生晚发型败血症(LOS)的预测因素,并构建极低出生体重儿生后3 d LOS风险评分表,为新生儿LOS的早期诊断和及时治疗提供参考。方法选取2022年1月1日至2024年6月30日复旦大学附属儿科医院收治的极低出生体重儿作为研究对象,根据是否发生LOS分为LOS组与无LOS组,采用LASSO回归及单因素和多因素回归分析筛选极低出生体重儿LOS的预测因素,基于最优预测变量组合构建Logistic回归模型,并构建风险评分表。采用Hosmer-Lemeshow χ^(2)检验及受试者工作特征曲线评价该模型的预测效果。结果共纳入444例极低出生体重儿,其中LOS患儿185例,无LOS患儿259例。经筛选变量后,最终纳入出生体重、胎龄、气管插管、皮肤颜色异常、腹胀、C-反应蛋白升高、右手灌注指数7个自变量进行模型构建,并根据各变量的回归系数构建了风险评分表,相应的风险评分依次为1、4、3、2、1、1、2分,评分≥3.5分为高风险人群。Hosmer-Lemeshow检验结果显示,χ^(2)=7.602,P=0.473;受试者工作特征曲线下面积为0.792(P<0.001),灵敏度为73.5%,特异度为71.0%。结论所构建的风险评分表的预测效果良好,可为临床医护人员在生后早期评估极低出生体重儿发生LOS的风险提供参考。
目的:研究极早产儿和极低出生体重儿动脉导管未闭的危险因素。方法:回顾性收集青岛大学附属烟台毓璜顶医院2019年1月~2022年12月收治的胎龄 Objective: To study the risk factors of patent ductus arteriosus in very preterm and very low birth weight infants. Methods: A retrospective collection of clinical data was conducted on very preterm infants with gestational age < 32 weeks or very low birth weight infants weighing < 1500 g who were admitted to Yantai Yuhuangding Hospital affiliated with Qingdao University from January 2019 to December 2022. The subjects were divided into two groups based on the ultrasound in the first 5 - 7 days after birth echocardiographic findings: the PDA group (263 cases) and the non-PDA (nPDA) group (262 cases). Univariate and binary logistic regression analyses were used to explore the risk factors of patent ductus arteriosus in very preterm and very low birth weight infants. Results: The results of univariate analyses showed that the occurrence of PDA was associated with premature rupture of membranes, cesarean section, gestational age, birth weight, maternal comorbidities with diabetes mellitus, prenatal use of glucocorticoids and antibiotics, asphyxia, respiratory distress syndrome, respiratory support, endotracheal intubation, caffeine and lung surfactant application, leukocyte counts, 1-minute Apgar score and 5-minute Apgar score (P < 0.05). Binary logistic regression analysis showed that premature rupture of membranes, antepartum use of dexamethasone, and elevated white blood cell counts are independent protective factors for PDA, and tracheal intubation at birth was an independent risk factor (P < 0.05). Conclusion: Identifying the risk factors for arterial ductus arteriosus in very preterm and very low birth weight infants as early as possible can help achieve individualized management of this condition.
