早产儿宫内感染性肺炎和支气管肺发育不良发生的高危因素

目的探讨早产儿宫内感染性肺炎和支气管肺发育不良（BPD）发生的危险因素。 方法收集2013年1月至2018年11月惠州市第六人民医院收治的宫内感染性肺炎早产儿600例为宫内感染性肺炎组，另选取同期无宫内感染性肺炎的早产儿600例为单纯早产组；比较两组早产儿的性别、宫内窘迫、胎膜早破> 24 h、羊水污染、第2产程延长、母孕晚期发热史、剖宫产、胎龄、出生体质量以及1 min阿氏评分（Apgar），并行多因素Logistic回归分析。收集2016年1月至2018年12月本院收治的BPD早产儿60例为BPD组，另取同期无BPD早产儿60例为非BPD组；比较两组早产儿的性别、宫内窘迫、肺出血、巨细胞病毒感染、有创机械通气治疗、出生2周内输注红细胞、宫内感染、胎龄、出生体质量以及1 min Apgar评分，并行多因素Logistic回归分析。 结果宫内感染性肺炎组早产儿宫内窘迫[224（37.33%） vs. 78（13.00%）]、胎膜早破> 24 h [308（51.33%） vs. 99（16.50%）]、母孕晚期发热史[117（19.50%） vs. 54（9.00%）]和BPD [133（22.17%） vs. 35（5.83%）]比例均显著高于单纯早产儿组，差异均有统计学意义（χ² = 94.320、162.408、27.068、66.473，P均< 0.001）；而1 min Apgar评分[（7.08 ± 1.32）分]显著低于单纯早产组[（8.65 ± 1.41）分]，差异有统计学意义（t = 19.911、P < 0.001）。多因素Logistic回归分析显示：宫内窘迫、胎膜早破> 24 h、母孕晚期发热史均为早产儿宫内感染性肺炎的独立危险因素（OR = 3.824、4.017、3.492，P = 0.001、0.008、0.015）。BPD组早产儿宫内窘迫[12（20.00%） vs. 3（5.00%）]、肺出血[10（16.67%） vs. 0（0.00%）]、巨细胞病毒感染[5（8.33%） vs. 0（0.00%）]、有创机械通气治疗[46（76.67%） vs. 2（3.33%）]、出生2周内输注红细胞[51（85.00%） vs. 2（3.33%）]、宫内感染[23（38.33%） vs. 6（10.00%）]比例均显著高于非BPD组，差异均有统计学意义（χ² = 6.171、10.909、5.217、67.222、81.138、13.141，P = 0.013、0.001、0.022、< 0.001、< 0.001、< 0.001）；而胎龄[（32.14 ± 1.20）周vs. （34.35 ± 2.74）周]、出生体质量[（1 352.39 ± 209.57）g vs. （2 285.56 ± 356.82）g]、1 min Apgar评分[（7.23 ± 1.36）分vs. （8.68 ± 1.75）分]显著低于非BPD组，差异均有统计学意义（t = 5.723、17.468、5.068，P均< 0.001）。多因素Logistic回归分析显示：巨细胞病毒感染、有创机械通气治疗、出生2周内输注红细胞、胎龄、出生体质量均为早产儿发生BPD的独立危险因素（OR = 44.357、3.082、3.290、4.738、3.409，P < 0.001、0.003、0.002、< 0.001、0.009）。 结论宫内窘迫、胎膜早破> 24 h、母孕晚期发热史可能增加早产儿宫内感染性肺炎发生的风险，而巨细胞病毒感染、有创机械通气治疗、出生2周内输注红细胞、胎龄、出生体质量可能影响BPD发生率。

Risk factors of intrauterine infective pneumonia and bronchopulmonary dysplasia in premature infants

ObjectiveTo investigate the risk factors of intrauterine infectious pneumonia and bronchopulmonary dysplasia (BPD) in premature infants. MethodsFrom January 2013 to November 2018, a total of 600 premature infants with intrauterine infectious pneumonia were collected from Huizhou the Sixth People’s Hospital of Huizhou City as intrauterine infectious pneumonia group, while 600 premature infants without infective pneumonia were selected as simple premature group during the same period. The sex, intrauterine distress, premature rupture of membranes > 24 h, amniotic fluid contamination, prolonged second stage of labor, history of late maternal fever, cesarean section, gestational age, birth mass, and 1 min Apgar score were compared between the above two groups, respectively; and multivariate Logistic regression analysis was performed. Total of 60 premature infants with BPD admitted to our hospital from January 2016 to December 2018 were collected as BPD group, while 60 cases of premature infants without BPD were collected as non-BPD group. The sex, intrauterine distress, pulmonary hemorrhage, cytomegalovirus infection, invasive mechanical ventilation therapy, transfusion of red blood cells within two weeks of birth, intrauterine infection, gestational age, birth mass, and 1 min Apgar score were compared between the above two groups, respectively; and multivariate Logistic regression analysis was performed. ResultsThe rates of intrauterine distress [224 (37.33%) vs. 78 (13.00%)], premature rupture of membranes > 24 h [308 (51.33%) vs. 99 (16.50%)], fever history of late pregnancy [117 (19.50%) vs. 54 (9.00%)] and BPD [133 (22.17%) vs. 35 (5.83%)] of cases in intrauterine infectious pneumonia group were significantly higher than those of simple premature group, with significant differences (χ² = 94.320, 162.408, 27.068, 66.473; all P < 0.001); but 1 min Apgar score [(7.08 ± 1.32) vs. (8.65 ± 1.41)] was significantly lower than that of simple premature group, with significant difference (t = 19.911, P < 0.001). Multivariate Logistic regression analysis showed that intrauterine distress, premature rupture of membranes > 24 h, history of advanced maternal fever were all independent risk factors of intrauterine infectious pneumonia in preterm infants (OR = 3.824, 4.017, 3.492; P = 0.001, 0.008, 0.015). The rates of intrauterine distress [12 (20.00%) vs. 3 (5.00%)], pulmonary hemorrhage [10 (16.67%) vs. 0 (0.00%)], cytomegalovirus infection [5 (8.33%) vs. 0 (0.00%)], invasive mechanical ventilation [46 (76.67%) vs. 2 (3.33%)], transfusion of red blood cells [51 (85.00%) vs. 2 (3.33%)] within two weeks of birth, intrauterine infection [23 (38.33%) vs. 6 (10.00%)] of cases in BPD group were significantly higher than those of non-BPD group, with significant differences (χ² = 6.171, 10.909, 5.217, 67.222, 81.138, 13.141; P = 0.013, 0.001, 0.022, < 0.001, < 0.001, < 0.001); but gestational age [(32.14 ± 1.20) weeks vs. (34.35 ± 2.74) weeks], birth mass [1 352.39 ± 209.57) g vs. (2 285.56 ± 356.82) g] and 1 min Apgar score [(7.23 ± 1.36) vs. (8.68 ± 1.75)] were significantly lower than those of non-BPD groups, with significant differences (t = 5.723, 17.468, 5.068; all P < 0.001). Multivariate Logistic regression analysis showed that cytomegalovirus infection, invasive mechanical ventilation therapy, transfusion of red blood cells within two weeks of birth, gestational age and birth mass were all independent risk factors for preterm infants with BPD (OR = 44.357, 3.082, 3.290, 4.738, 3.409; P < 0.001, 0.003, 0.002, < 0.001, 0.009). ConclusionsEndometrial distress, premature rupture of membranes > 24 h, history of fever may increase the risk of intrauterine infectious pneumonia in preterm infants, and cytomegalovirus infection, invasive mechanical ventilation therapy, transfusion of red blood cells within two weeks of birth, gestational age, and birth mass may affect BPD incidence.