极低/超低出生体重儿生后1 min低Apgar评分的危险因素：多中心回顾性研究

Risk factors for low Apgar score at 1 minute after birth in very low/extremely low birth weight infants: a retrospective multicenter study

摘要:

目的 探讨极低/超低出生体重儿生后1 min低Apgar评分（≤7分）的危险因素。方法 回顾性收集2018年1月—2019年12月江苏省新生儿重症监护病房母乳喂养质量改进临床研究协作组多中心临床数据库极低/超低出生体重儿的临床资料。按生后1 min Apgar评分分为低Apgar评分组（Apgar评分≤7分）和正常Apgar评分组（Apgar评分>7分）。采用多因素logistic回归分析法探讨生后1 min低Apgar评分的影响因素。采用受试者操作特征曲线（receiver operating characteristic curve, ROC曲线）分析评价相关指标对生后1 min低Apgar评分的预测价值。结果 纳入1 809例极低/超低出生体重儿。1 min低Apgar评分发生率为52.90%（957/1 809）。多因素logistic回归分析显示：胎龄越大，患儿出现1 min低Apgar评分的风险越小（OR=0.853，P<0.05）；出生体重越大，患儿出现1 min低Apgar评分的风险越小（OR=0.999，P<0.05）；羊水异常的患儿出现1 min低Apgar评分的风险较高（OR=1.646，P<0.05）；产前使用糖皮质激素的患儿出现1 min低Apgar评分的风险较低（OR=0.502，P<0.05）。ROC曲线分析显示，胎龄、出生体重、羊水异常和产前使用糖皮质激素4个指标联合预测出现1 min低Apgar评分的灵敏度为0.554，特异度为0.680。结论 低胎龄、低出生体重、羊水异常可增加极低/超低出生体重儿生后1 min低Apgar评分的风险，产前积极使用糖皮质激素有利于降低生后1 min低Apgar评分的风险。

Abstract:

Objective To investigate the risk factors for low Apgar score (≤7) at 1 minute after birth in very low/extremely low birth weight infants.Methods Clinical data of very low/extremely low birth weight infants were retrospectively collected from January 2018 to December 2019 in the multicenter clinical database of the Jiangsu Multicenter Study Collaborative Group for Breastmilk Feeding in Neonatal Intensive Care Units. The infants were divided into two groups: low Apgar score group (Apgar score ≤7) and normal Apgar score group (Apgar score >7) based on the Apgar score at 1 minute after birth. Multivariable logistic regression analysis was used to identify factors associated with low Apgar score at 1 minute after birth. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of relevant indicators for low Apgar score at 1 minute after birth.Results A total of 1 809 very low/extremely low birth weight infants were included. The incidence of low Apgar score at 1 minute was 52.90% (957/1 809). Multivariable logistic regression analysis showed that older gestational age (OR=0.853, P<0.05) and higher birth weight (OR=0.999, P<0.05) were associated with a lower risk of low Apgar score at 1 minute, while the presence of abnormal amniotic fluid (OR=1.646, P<0.05) and antenatal use of glucocorticoids (OR=0.502, P<0.05) were associated with a higher and lower risk, respectively. ROC curve analysis showed that the combination of gestational age, birth weight, abnormal amniotic fluid, and antenatal use of glucocorticoids had a sensitivity of 0.554 and specificity of 0.680 in predicting low Apgar score at 1 minute.Conclusions Younger gestational age, lower birth weight, and abnormal amniotic fluid increase the risk of low Apgar score at 1 minute after birth in very low/extremely low birth weight infants, while antenatal use of glucocorticoids can reduce this risk.