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。
Abstract
Objective To describe the distribution of temperature at admission in very low birth weight infants (VLBWIs) and/or premature infants with a gestational age≤32 weeks, 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, 248 VLBWIs (birth weight＜1 500 g) and/or premature infants with gestational age≤32 weeks 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 248 VLBWIs (birth weight＜1 500 g) 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 5 min Apgar score ≤7 and 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≤32 weeks 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.
关键词
低体温 /
早产儿 /
极低出生体重儿 /
危险因素 /
质量改进
Key words
hypothermia /
premature infants /
very low birth weight infant /
risk factor /
quality improvement
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