早产儿贫血的相关因素分析

目的：贫血是早产儿生后常见的现象，严重影响了早产儿的生长发育，甚至危及生命。目前早产儿贫血的病因尚不明确。该文通过回顾性病例对照研究，分析早产儿贫血的发生与各种围产因素的相关性。方法：收集北京大学第三医院儿科2005年1月至2006年12月两年期间生后24 h内收入新生儿病房的165例早产儿的临床资料数据，按是否发生贫血，分贫血组和对照组两组，进行与贫血有关的围产因素的分析。结果：165例早产儿中发生贫血63例，占总例数的38.1％。贫血组胎龄、出生体重明显低于对照组，分别为32.5±2.0 vs 33.7±1.9周，1 682.7±393.9 vs 2 041.1±510.1 g；而采血量、住院天数则明显高于对照组，分别为12.4±6.5 vs 6.6±3.6 mL/kg，25.6±14.2 vs 14.1±8.7 d，差异均有统计学意义(均P<0.01)；贫血组的危重患儿比例较对照组高(33.3% vs 9.8%)，差异有非常显著意义(P<0.01)；贫血组母亲先兆子痫比例较对照组高(44.4% vs 28.4%)，差异有显著意义(P<0.05)。多因素logistic回归分析显示早产儿贫血发生的危险因素为采血量，与采血量＜5 mL/kg组相比，5～10 mL/kg组OR值为1.737(95% CI：0.699~ 4.316)，P>0.05；10～15 mL/kg组OR值为4.141 (95% CI:1.573~10.905)，P<0.01；≥15 mL/kg组OR值为32.267(95% CI:8.053~129.287)，P＜0.01。结论：早产儿贫血与胎龄小、出生体重低、采血量大、住院时间长、病情重、母亲患先兆子痫多种因素有关，而采血量是早产儿贫血发生的危险因素，2周内采血量累计10～15 mL/kg组发生贫血的危险性是＜5 mL/kg组的4倍，≥15 mL/kg 组发生贫血的危险性是＜5 mL/kg组的32倍。

Related factors in the development of anemia in preterm infants

OBJECTIVE: To investigate the related perinatal factors in the development of anemia of prematurity by a case-control study. METHODS: The medical data of 165 preterm infants admitted to the department of neonatology in Peking University Third Hospital from January 2005 to December 2006 were retrospectively reviewed. The infants were classified into two groups: anemia and non-anemia (control). The factors associated with anemia of prematurity were identified. RESULTS: Sixty-three preterm infants (38.1%) had anemia. The gestational age (32.5±2.0 weeks vs 33.7±1.9 weeks) and birth weight (1 682.7±393.9 g vs 2 041.1±510.1 g) of the anemia group were significantly lower than those of the control group (P<0.01). The blood loss from laboratory testing (12.4±6.5 mL/kg vs 6.6±3.6 mL/kg) and the duration of hospital stay (25.6±14.2 days vs 14.1±8.7 days) of the anemia group were significantly higher than those of the control group (P<0.01). More critically ill patients (33.3%) were noted in the anemia group compared with in the control group (9.8%) (P<0.01). In the anemia group, 44.4% of the mothers had preeclampsia but only 28.4% in the control group (P<0.05). Multiple factor logistic regression analysis revealed that the blood loss from laboratory testing was the only independent high-risk factor for anemia of prematurity. Compared with the preterm infants whose blood loss from laboratory testing was <5 mL/kg, the OR values of the preterm infants whose blood loss was 5-10, 10-15 and ≥15 mL/kg was 1.737 (95% CI: 0.699-4.316, P>0.05), 4.141 (95% CI: 1.573-10.905, P<0.01) and 32.267 (95% CI: 8.053-129.287, P<0.01), respectively. CONCLUSIONS:Anemia of prematurity is associated with gestational age, birth weight, duration of hospital stay, illness severity and maternal preeclampsia. The blood loss from laboratory testing is an independent risk-factor in the development of anemia of prematurity.