极低出生体重儿和/或胎龄小于32周早产儿入院低体温发生的危险因素分析

目的 分析极低出生体重儿和/或胎龄小于32周早产儿入院体温的分布情况及低体温发生的危险因素,为降低入院低体温的发生率提供理论依据。方法 选取2019年1月1日-2020年12月31日聊城市人民医院出生的极低出生体重儿(出生体重＜1 500 g)和/或胎龄＜32周早产儿共248例为研究对象;根据入院体温分为正常体温组(入院体温为36.5℃～37.5℃)122例、轻度低体温组(入院体温为36.0℃～36.4℃)98例、中度低体温组(入院体温为32.0℃～35.9℃)27例,记录三组病例的入院体温、一般资料及围生期资料,并进行统计分析。 结果 248例极低出生体重儿和/或胎龄小于32周早产儿,入院体温波动于34.8℃～38.0℃,平均体温(36.37±0.44)℃。单因素分析及组间比较结果显示,中度低体温组胎龄、剖宫产比例小于正常体温组(H=12.316、χ²=7.739,P<0.05),出生时气管插管的比例大于正常体温组(χ²=22.907, P<0.05);中度低体温组和轻度低体温组出生体重小于正常体温组(H=26.060,P<0.05),5 min Apgar评分≤7分及窒息复苏的比例大于正常体温组(χ²= 27.594、23.879, P<0.05)。多因素Logistic回归分析结果显示,出生体重(OR=0.997, 95%CI:0.996～0.999)、多胎(OR=2.279, 95%CI:1.106～4.694)和窒息复苏(OR=3.265, 95%CI:1.209～8.819)为低体温的独立影响因素(P＜0.05)。结论 极低出生体重儿和/或胎龄小于32周早产儿低体温的发生与多种因素相关,其中出生体重、多胎和窒息复苏是导致低体温的独立危险因素,可通过持续质量改进方案降低其入院低体温的发生率。

Study on risk factors of hypothermia at admission in very low birth weight infants and/or premature infants with gestational age less than 32 weeks

Objective To describe the distribution of temperature at admission in very low birth weight infants(VLBWIs)and/or premature infants with a gestational age≤32weeks,and to analyze the risk factors of hypothermia,in order to provide clinical evidence for reducing the incidence of admission hypothermia.Methods From 1st January,2019 to 31st December,2020,248VLBWIs(birth weight<1500g)and/or premature infants with gestational age≤32weeks admitted to Neonatal Intensive Care Unit(NICU)of Liaocheng People′s Hospital were enrolled in this study.Then the participants were divided into normothermia group(36.5℃-37.5℃,n=122),mild hypothermia group(36.0℃-36.4℃,n=98)and moderate hypothermia group(32.0℃-35.9℃,n=27).The admission temperature,general and perinatal conditions of the three groups were recorded and compared.Results The admission temperature ranged from 34.8℃to 38.0℃in 248VLBWIs(birth weight<1500g)and/or premature infants with gestational age≤32 weeks,and the average temperature is(36.37±0.44)℃.Univariate analysis showed that compared with the normothermia group,the gestational age and the proportion of cesarean section were lower in moderate hypothermia group(H=12.316,χ²=7.739,P<0.05),and the proportion of endotracheal intubation at birth was higher moderate hypothermia group(χ²=22.907,P<0.05).Compared with the normothermia group,the birth weight of infants in mild and moderate hypothermia group was lower(H=26.060,P<0.05),while the proportion of 5min Apgar score≤7and resuscitation were higher(χ²=27.594,23.879,P<0.05).Multivariate Logistic regression analysis showed that higher birth weight was associated with lower risk of hypothermia(OR=0.997,95%CI:0.996-0.999),while multiple births and resuscitation were independently risk factors of hypothermia(OR=2.279,95%CI:1.106-4.694;OR=3.265,95%CI:1.209-8.819,P<0.05).Conclusions The occurrence of hypothermia in VLBWIs and/or premature infants with gestational age≤32weeks is associated with a number of factors,including birth weight,multiple births and resuscitation by asphyxia as independent risk factors for hypothermia,and the incidence of admission hypothermia can be reduced through continuous quality improvement programs.