超早产儿出生时间与复苏结局的关系

Association between time of birth and resuscitation outcomes in extremely preterm infants

摘要:

目的 探讨非工作时间（工作日夜间6 pm~8 am、周末和国家法定节假日）出生的与正常工作时间出生的超早产儿复苏过程和早期结局有无差异。方法 回顾性收集2010年1月1日至2020年12月31日于北京大学第三医院出生并转入新生儿重症监护病房的超早产儿病例。根据出生时间的不同分为工作时间出生组（n=77）和非工作时间出生组（n=98），比较两组的复苏过程和早期结局的差异。结果 非工作时间出生组分娩前足量应用地塞米松的比例低于工作时间出生组（P < 0.05），生后1 min Apgar评分 < 7分、正压通气、气管插管比例高于工作时间出生组（P < 0.05），新生儿呼吸窘迫综合征、宫内感染性肺炎发生率高于工作时间出生组（P < 0.05）。结论 非工作时间出生的超早产儿生后1 min Apgar评分较低，复苏时需要正压通气、气管插管比例高于工作时间出生的早产儿，且易发生新生儿呼吸窘迫综合征、宫内感染性肺炎。需要为超早产儿生后复苏做好充分的人力和物品的准备，新生儿重症监护病房应制定超早产儿出生前-出生时-出生后各时段详尽的管理方案。

Abstract:

Objective To study whether there are differences in the resuscitation process and early outcomes between the extremely preterm infants delivered on off-hours (6 pm to 8 am of working days, weekends, and national holidays) and those delivered on working hours. Methods A retrospective analysis was performed on the medical data of extremely preterm infants who were born in the Peking University Third Hospital from January 1, 2010 to December 31, 2020 and transferred to the neonatal intensive care unit (NICU). According to the time of birth, they were divided into two groups:working hours (n=77) and off-hours (n=98). The resuscitation process and early outcomes were compared between the two groups. Results Compared with the working hours group, the off-hours group had a significantly lower proportion of infants with the use of full-dose dexamethasone before delivery (P < 0.05) and a significantly higher proportion of infants with a 1-minute Apgar score of < 7, positive pressure ventilation, or tracheal intubation (P < 0.05). The incidence rates of neonatal respiratory distress syndrome and intrauterine pneumonia in the off-hours group were significantly higher than those in the working hours group (P < 0.05). Conclusions Extremely preterm infants delivered on off-hours tend to have a low Apgar score at 1 minute after birth, with a higher proportion of infants requiring positive pressure ventilation or tracheal intubation during resuscitation than those delivered on working hours, and they tend to develop neonatal respiratory distress syndrome and intrauterine pneumonia. This suggests that it is important to make adequate preparations in terms of personnel and supplies for resuscitation of extremely preterm infants after birth and that NICUs should develop a detailed management plan for extremely preterm infants at each period of time before, during, and after birth.