多中心大于胎龄儿新生儿期死亡原因及风险的病例对照研究

目的探讨大于胎龄儿（LGA）新生儿期死亡原因及死亡风险。方法病例对照研究。《中国新生儿死亡原因多中心调查》数据库包括39家三级医院新生儿科胎龄≥24周的所有死亡病例数据，以数据库中的LGA为病例组（单胎出生，晚期早产儿或足月儿），分别以数据库中全部适于胎龄儿（AGA）和配对的AGA（1∶1）为对照组（匹配条件：单胎、胎龄、性别、来源医院），比较LGA和AGA新生儿期死亡原因。通过整体人群中LGA和AGA活产婴儿比例，估计整体人群LGA死亡风险。采集母亲因素、围生期因素、新生儿因素和死亡原因。根据WHO ICD-PM分类标准分为11类新生儿期死亡原因。结果2016年7月1日至2019年6月30日数据库中新生儿期死亡的LGA和AGA分别为126和1 183例。LGA组新生儿除出生体重、母亲妊娠期糖尿病患病率外均与匹配AGA组差异无统计学意义。多因素回归分析，矫正出生体重和妊娠期糖尿病因素，LGA组早期新生儿死亡风险较匹配AGA组增加1.94倍（OR=2.938，95%CI: 1.346~6.416,P=0.007）。LGA的主要死亡原因排序为先天性疾病（29.4%）、围产期窒息（21.4%）、呼吸系统疾病和心血管疾病（14.3%）、重症感染（11.9%）。LGA组新生儿全因死亡风险与匹配AGA组差异无统计学意义，LGA组死于重症感染（N6：细菌性败血症,细菌脑膜炎，肺炎，病毒感染等）的风险低于匹配AGA组（OR=0.541，95%CI：0.320~0.912，P=0.019）。结论国内三级医院晚期早产儿和足月单胎LGA的主要死亡原因构成及其比例与AGA相比总体一致，LGA并不增加新生儿期的死亡风险，且死于重症感染风险低于AGA。

Death causes and mortality risks of large for gestational age infants: A multi-center case-control study

ObjectiveTo identify the neonatal death cause and mortality risk of large for gestational age infants(LGA). MethodsThis was a retrospective case-control study based on a Chinese multicenter neonatal death database including 39 tertiary hospitals. The database recruited all death cases with gestational age(GA) ≥24 weeks. Singleton LGA infants with GA of 34-41 weeks were compared with overall AGA or GA/gender/hospital-matched AGA. Mortality risk of LGA in whole population was estimated based on assumptive ratio of LGA∶AGA of 1∶8. Clinical characteristics, including maternal diseases, perinatal and neonatal factors were extracted from the database. The primary death causes were reclassified based on ICD-PM criteria issued by WHO. ResultsFrom July 2016 to June 2019, 126 LGA and 1,183 AGA met the inclusion criteria. Except maternal diabetes and birth weight, all other clinical characteristics were not significantly different between LGA and matched AGA. After adjustment of birth weight and maternal diabetes, multivariable logistic analyses demonstrated that LGA had 1.94 higher chance of dying in early neonatal period compared with matched AGA (OR=2.938，95%CI:1.346~6.416,P=0.007）. Congenital anomalies (29.4%), perinatal asphyxia (21.4%), respiratory and cardiovascular disease (14.3%), severe infection (11.9%) were four major death causes for LGA infants. The whole population estimation demonstrated that LGA shared similar overall mortality risk with matched AGA, but less mortality risk from severe infection (including sepsis, meningitis, pneumonia and virus infection; OR=0.541, 95%CI:0.320~0.912,P=0.019）. ConclusionIn tertiary Chinese hospitals, the spectrum of death cause was not significantly different between singleton LGA and AGA infants born at late preterm or term. For whole population, LGA seemed to have similar all-cause mortality risk, but less risk of dying from infection compared with AGA infants.