【目的】 探讨极低出生体重(very low birth weight,VLBW)儿早期死亡的围生期高危因素。 【方法】 选取在本院新生儿科住院的143例VLBW儿为研究对象。生后7 d 的结果:生存或死亡作为应变量,根据分层分析模型将围产期高危因素(自变量)分为远端、中间和近端3层,然后采用单因素和多因素Logistic 回归对所有变量进行分析。 【结果】 VLBW婴儿早期死亡率为13.29%(19/143)。变量经多因素Logistic 回归调整后显示,远端因素中母亲分娩时合并脐带脱垂者明显增加了VLBW 婴儿早期死亡的危险(AOR:8.69,95%CI:1.128 ~ 67.002);中间因素中胎龄<28周或生后5 min Apgar 评分<7分的VLBW 婴儿有明显高的早期死亡的危险(AOR:11.47,13.55;95%CI:2.066~63.712,3.156~58.221);近端因素中婴儿合并颅内出血者亦有明显高的早期死亡危险(AOR:4.56,95%CI:1.088~19.170)。 【结论】 VLBW婴儿早期死亡率高,是一个严重的公共健康问题。出生时窒息是死亡的最危险因素,通过提高产科质量、加强产科和新生儿科合作,降低窒息的发生是减少此类患儿早期死亡的关键。

【Objective】 To investigate the relationship between perinatal risk factors and early neonatal death among very low birth weight (VLBW) infants. 【Methods】 A retrospective cohort of 143 VLBW infants admitted to NICU was studied.The dependent variable was the outcome,either survival or death at 7 days of life.The independent variables were assigned into three levels:distal,intermediate and proximal according to hierarchical model.All variables were subjected to univariate analysis and multivariate logistic regression. 【Results】 Early neonatal mortality was 13.29% (19/143) in VLBW infants.After the adjustment of variables through multivariate Logistic regression it showed that infants born to mother with cord prolapse had higher risk exposure for early death than those of mother without cord prolapse in the distal level (AOR:8.69;95%CI:1.128~67.002).At the intermediate level,infants with gestational age (GA)<28 weeks and 5-min Apgar scores<7 had higher odds of early death than those of GA≥28 weeks and 5-min Apgar scores≥7 (AOR:11.47,13.55;95%CI:2.066~63.712,3.156~58.221 respectively).At the proximal level,infants with intracranial hemorrhage (ICH) had higher risk of early death than those without ICH (AOR:4.56,95%CI:1.088~19.170). 【Conclusions】 The early neonatal mortality among VLBW infants is still high and continues to be a significant public health problem.Asphyxia at birth is the highest risk factor of early neonatal death.Reducing birth asphyxia through enhancing obstetric quality and strengthening cooperation between obstetric and neonatology department is still the key to decrease early neonatal death of VLBW infants.