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【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7d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5min 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 perinatal risk factors of early death in very low birth weight (VLBW). 【Methods】 A total of 143 VLBW children hospitalized in neonatal department of our hospital were selected as the research object. 7d after birth: survival or death as a dependent variable, according to stratified analysis model perinatal risk factors (independent variables) into remote, middle and proximal 3 layers, and then using single factor and multivariate Logistic regression All variables are analyzed. 【Results】 The infant mortality rate in VLBW was 13.29% (19/143). The variables adjusted by multivariate Logistic regression showed that the risk of early death of VLBW infants was significantly increased in the distal group with mother-child umbilical cord prolapse (AOR: 8.69, 95% CI: 1.128 to 67.002); among the intermediate factors, gestational age VLBW infants with an Apgar score <7 at 28 weeks or 5 minutes after birth had a significantly higher risk of early death (AOR: 11.47, 13.55; 95% CI: 2.066 to 63.712, and 3.156 to 58.221) Internal bleeding also had a significantly higher risk of early death (AOR: 4.56, 95% CI: 1.088-19.170). 【Conclusion】 The high early infant mortality rate in VLBW infant is a serious public health problem. Asphyxia at birth is the most risky cause of death and the key to reducing early death in such children is to improve the quality of obstetrics and strengthen cooperation between obstetrics and neonatology to reduce the incidence of asphyxia.