胎膜早破和羊水过少对胎龄<32周早产儿住院结局的影响

doi:10.12372/jcp.2024.23e0774

Abstract

Abstract:

Objective To investigate the effects of premature rupture of membranes (PPROM) or oligohydramnios on in-hospital outcomes of preterm infants with gestational age<32 weeks. Methods The clinical data of preterm infants with gestational age<32 weeks who were hospitalized from January 2019 to December 2022 were retrospectively analyzed. The patients were divided into PPROM group and normal group according to the presence or absence of PPROM. PPROM patients combined with oligohydramnios were further included in the oligohydramnios group. The clinical features were compared among the groups. Multivariate logistic regression was used to analyze the effects of PPROM and oligohydramnios on in-hospital outcomes of preterm infants<32 weeks of gestational age. Results A total of 195 preterm infants were included, 83 in the PPROM group, 22 in the oligohydramnios group. There were 112 neonates in the normal group. The median gestational age of PPROM was 29.5 (28.5-30.5) weeks, and the median duration was 48.0 (13.8-85.8) hours. Multivariate logistic regression analysis showed that oligohydramnios was an independent risk factor for death before discharge, hemodynamically significant patent ductus arteriosus (hsPDA) and persistent pulmonary hypertension (PPHN) (P<0.05). The PPROM duration≥168h significantly increased the incidence of PPHN (P<0.05). Compared with the group with only PPROM, the group with both PPROM and oligohydramnios had a longer duration of PPROM, a smaller gestational age at the time of PPROM, and a smaller gestational age at birth, with statistically significant differences (P<0.05). Conclusions The effects of PPROM and oligohydramnios on neonatal prognosis are different. There was no significant correlation between PPROM and premature death and neonatal related diseases. However, PPROM with long duration and oligohydramnios is potentially dangerous for premature infants. Oligohydramnios is closely related to premature death, PPHN and other adverse outcomes.

Key words: preterm premature rupture of membrane, oligohydramnios, premature infant

ZHU Jingwen, HE Xiyu. Effects of premature rupture of membranes and oligohydramnios on in-hospital outcomes of preterm infants with gestational age <32 weeks[J].Journal of Clinical Pediatrics, 2024, 42(7): 613-618.

Figures/Tables 5

References 30

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项目	正常组(n=112)	PPROM组(n=83)	统计量	P
出生胎龄[M(P₂₅~P₇₅)]/周	30.0(28.6~31.0)	29.4(28.3~30.4)	Z=2.07	0.039
出生体重[M(P₂₅~P₇₅)]/g	1 315.0(1 160.0~1 450.0)	1 210.0(1 100.0~1 350.0)	Z=2.41	0.016
小于胎龄儿[n(%)]	11(9.8)	7(8.4)	χ²=0.11	0.741
男性[n(%)]	65(58.0)	47(56.6)	χ²=0.04	0.844
多胎[n(%)]	3(2.6)	4(4.8)	－	0.462¹⁾
宫内窘迫[n(%)]	10(8.9)	6(7.2)	χ²=0.18	0.669
剖宫产[n(%)]	55(49.1)	45(54.2)	χ²=0.50	0.480
1分钟Apgar评分[M(P₂₅~P₇₅)]/分	9.0(8.0~10.0)	6.0(8.0~10.0)	Z=1.03	0.305
5分钟Apgar评分[M(P₂₅~P₇₅)]/分	10.0(9.0~10.0)	9.0(8.0~10.0)	Z=1.12	0.263
母亲年龄[M(P₂₅~P₇₅)]/岁	25.0(24.0~33.0)	31.0(25.0~35.0)	Z=1.73	0.083
初产[n(%)]	34(30.3)	27(32.5)	χ²=0.11	0.746
组织学绒毛膜羊膜炎[n(%)]	25(22.3)	38(45.7）	χ²=12.00	0.001
母亲糖尿病[n(%)]	29(25.8)	17(20.4)	χ²=0.77	0.379
胎盘早剥[n(%)]	6(5.3)	5(6.0)	－	0.842¹⁾
产前规范应用激素[n(%)]	85(75.8)	68(81.9)	χ²=1.03	0.311
试管婴儿[n(%)]	6(5.3)	3(3.6)	－	0.735¹⁾

项目	正常组(n=112)	PPROM组(n=83)	统计量	P
呼吸窘迫综合征(Ⅲ~Ⅳ)[n(%)]	102(91.0)	75(90.4)	χ²=0.03	0.866
大量肺出血[n(%)]	2(1.7)	2(2.4)	－	0.611¹⁾
PPHN[n(%)]	9(8.0)	9(10.8)	χ²=0.45	0.503
气漏综合征[n(%)]	3(2.7)	6(7.2)	－	0.173¹⁾
中重度BPD[n(%)]	42(37.5)	24(28.9)	χ²=1.57	0.210
机械通气时间[M(P₂₅~P₇₅)]/d	9.0(4.0~17.0)	7.0(4.5~13.5)	χ²=1.21	0.225
脓毒病[n(%)]	17(15.1)	9(10.8)	χ²=0.78	0.379
NEC[n(%)]	10(8.9)	5(6.0)	χ²=0.57	0.590
严重IVH[n(%)]	5(4.4)	5(6.0)	χ²=0.24	0.746
囊性PVL[n(%)]	8(7.1)	4(4.8)	－	0.562¹⁾
hsPDA[n(%)]	21(18.7)	14(16.8)	χ²=0.12	0.735
需要治疗ROP[n(%)]	4(3.5)	2(2.4)	－	1.000¹⁾
出院前死亡[n(%)]	2(1.7)	5(6.0)	－	0.116¹⁾
住院时间²⁾[M(P₂₅~P₇₅)]/d	49.0(36.0~60.0)	53.0(43.0~63.0)	Z=1.71	0.087
出院时体重²⁾[M(P₂₅~P₇₅)]/g	2 110.0(2 080.0~2 300.0)	2 100.0(2 090.0~2 305.0)	Z=0.76	0.450

项目	正常组(n=112)	羊水过少(n=22)	统计量	P
呼吸窘迫综合征(Ⅲ~Ⅳ)[n(%)]	102(91.0)	20(90.9)	－	0.981¹⁾
大量肺出血[n(%)]	2(1.7)	1(4.5)	－	0.446¹⁾
PPHN[n(%)]	9(8.0)	7(31.8)	χ²=9.89	0.002
气漏综合征[n(%)]	3(4.4)	3(13.6)	－	0.014¹⁾
中重度BPD[n(%)]	42(37.5)	10(45.4)	χ²=0.49	0.484
机械通气时间[M(P₂₅~P₇₅)]/d	9.0(4.0~17.0)	8.0(4.0~15.0)	Z=0.47	0.636
脓毒病[n(%)]	17(15.1)	5(22.7)	χ²=0.76	0.360
NEC[n(%)]	10(8.9）	3(13.6)	－	0.448¹⁾
严重IVH[n(%)]	5(4.4)	3(13.6)	χ²=2.76	0.124
囊性PVL[n(%)]	8(7.1)	1(4.5)	－	1.000¹⁾
hsPDA[n(%)]	21(18.7)	9(40.9)	χ²=5.20	0.023
需要治疗ROP[n(%)]	4(3.5)	1(4.5)	－	0.248¹⁾
出院前死亡[n(%)]	2(1.7)	4(13.6)	－	0.031¹⁾
住院时间²⁾[M(P₂₅~P₇₅)]/d	49.0(36.0~60.0)	50.0(39.0~63.5)	Z=1.95	0.052
出院时体重²⁾[M(P₂₅~P₇₅)]/g	2 110.0(2 090.0~2 300.0)	2 110.0(2 090.0~2 300.0)	Z=0.03	0.973

因素	气漏综合征¹⁾	PPHN²⁾	hsPDA³⁾	出院前死亡⁴⁾
PPROM	2.49(0.52~11.99)	1.60(0.51~5.01)	0.75(0.32~1.76)	0.74(0.32~1.73)
PPROM持续时间⁵⁾
<24 h	0.50(0.04~6.33)	1.78(0.37~8.46)	0.13(0.01~1.20)	0.04(0.00~19.13)
24~72 h	2.27(0.45~11.47)	1.23(0.21~7.07)	0.52(0.10~2.58)	－
72~168 h	2.39(0.08~69.22)	1.69(0.22~12.96)	4.09(0.94~17.81)	3.78(0.85~16.80)
≥168 h	2.15(0.22~21.37)	16.73(3.11~89.95)	2.71(0.52~4.19)	15.45(0.98~68.21)
羊水减少	0.62(0.10~3.67)	5.53(1.64~18.63)	4.40(1.15~12.80)	4.61(1.60~13.29)

项目	仅存在PPROM组(n=61)	PPROM合并羊水减少组(n=22)	Z值	P
PPROM持续时间[M(P₂₅~P₇₅)]/h	32.0(11.0~48.5)	48.0(12.3~174.0)	2.32	0.021
PPROM发生时胎龄[M(P₂₅~P₇₅)]/周	29.3(28.3~30.4)	27.2(26.3~29.3)	3.93	0.000
出生孕周[M(P₂₅~P₇₅)]/周	29.5(28.5~31.0)	28.2(27.0~29.6)	3.01	0.003

Effects of premature rupture of membranes and oligohydramnios on in-hospital outcomes of preterm infants with gestational age <32 weeks

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