Risk factors for hospitalization within 24 h postnatally and respiratory support in late preterm and term neonates

TANG Shuqing; WANG Li; PENG Lu; LIU Hui

doi:10.16016/j.2097-0927.202408040

您当前的位置：

首页 >

文章列表页 >

Risk factors for hospitalization within 24 h postnatally and respiratory support in late preterm and term neonates

Clinical Medicine | 更新时间：2025-03-11

- Risk factors for hospitalization within 24 h postnatally and respiratory support in late preterm and term neonates
- Journal of Army Medical University Vol. 47, Issue 5, Pages: 472-479(2025)
- 作者机构：
  
  1.重庆医科大学附属大学城医院儿科，重庆
  2.重庆医科大学附属第二医院儿科，重庆
- 作者简介：
- 基金信息：
  
  the General Joint Medical Research Project of Chongqing Science and Technology Commission and Chongqing Health Commission(2023MSXM048)
- DOI：10.16016/j.2097-0927.202408040
  CLC： R181.32;R473.72;R715.8
- Received：12 August 2024，
  
  Revised：08 January 2025，
  
  Published：15 March 2025
- 稿件说明：
移动端阅览
唐书庆，汪丽，彭露，等.近足月及足月新生儿出生后24 h内住院及呼吸支持治疗的危险因素分析［J］.陆军军医大学学报，2025，47（05）：472-479.DOI：10.16016/j.2097-0927.202408040.

TANG S Q，WANG L，PENG L，et al.Risk factors for hospitalization within 24 h postnatally and respiratory support in late preterm and term neonates［J］.J Army Med Univ，2025，47（05）：472-479.DOI：10.16016/j.2097-0927.202408040.
唐书庆，汪丽，彭露，等.近足月及足月新生儿出生后24 h内住院及呼吸支持治疗的危险因素分析［J］.陆军军医大学学报，2025，47（05）：472-479.DOI：10.16016/j.2097-0927.202408040. DOI：

TANG S Q，WANG L，PENG L，et al.Risk factors for hospitalization within 24 h postnatally and respiratory support in late preterm and term neonates［J］.J Army Med Univ，2025，47（05）：472-479.DOI：10.16016/j.2097-0927.202408040. DOI：

摘要

目的

探究近足月及足月新生儿出生后24 h内住院及呼吸支持治疗的危险因素。

方法

采用病例对照研究，选取2023年1月至2024年3月在重庆医科大学附属大学城医院产科娩出34周≤胎龄

42周的1 468例新生儿为研究对象，收集其母亲孕期及新生儿病例资料。根据出生后24 h内是否入住新生儿病房分为住院组和非住院组，并对因感染性疾病住院的新生儿进行亚组分析，根据有无呼吸支持治疗分为呼吸支持治疗组与无呼吸支持治疗组。分别比较各组间围产期危险因素，并寻找引起近足月及足月新生儿出生后24 h内住院及需要呼吸支持治疗的独立危险因素。将单因素分析中

0.1的指标纳入多因素Logistic回归分析，采用逐步回归方法，拟合多因素Logistic回归模型。

结果

住院组213例（14.5%），非住院组1 255例（85.5%）；因感染性疾病住院的新生儿共150例，呼吸支持治疗组48例（32.0%），无呼吸支持治疗组102例（68.0%）。多因素Logistic回归分析显示，母亲未正规产检（

OR=

2.687，95%

：1.175~6.141，

0.019）、胎儿宫内发育迟缓（

OR=

2.711，95%

：1.106~6.646，

0.029）、胎膜早破（

OR=

1.667，95%

：1.139~2.438，

0.008）、绒毛膜羊膜炎（

OR=

4.852，95%

：2.114~11.135，

0.001）、产前1周患感染性疾病（

OR=

1.531，95%

：1.015~2.310，

0.042）、羊水浑浊（

OR=

3.170，95%

：2.099~4.787，

0.001）、胎盘异常（

OR=

2.335，95%

：1.202~4.534，

0.012）、妊娠期其他并发症（

OR=

2.367，95%

：1.360~4.118，

0.002）、产前应用糖皮质激素（

OR=

2.744，95%

：1.219~5.528，

0.009）与近足月及足月新生儿出生后24 h内住院呈正相关，胎龄（

OR=

0.693，95%

：0.602~0.79

7，

0.001）、Apgar 5分钟评分（

OR=

0.026，95%

：0.003~0.212，

0.001）、脐血pH（

OR=

0.044，95%

：0.002~0.793，

0.034）、脐血BE（

OR=

0.885，95%

：0.823~0.823，

0.001）与其呈负相关。胎膜早破（

OR=

0.207，95%

：0.070~0.618，

0.005）、产前1周患感染性疾病（

OR=

0.245，95%

：0.070~0.854，

0.027）、Apgar 5分钟评分（

OR=

0.063，95%

：0.008~0.526，

0.011）、新生儿C反应蛋白异常（

OR=

0.145，95%

：0.046~0.460，

0.001）与因感染性疾病住院新生儿需呼吸支持治疗呈负相关。

结论

母亲未正规产检、胎儿宫内发育迟缓、胎膜早破等是近足月及足月新生儿出生后24 h内住院的危险因素；胎膜早破、产前1周患感染性疾病、Apgar 5分钟评分等是因感染性疾病住院新生儿需呼吸支持治疗的保护因素。

Abstract

Objective‍ To explore the risk factors of hospitalization within 24 h after birth and respiratory support in late preterm and term neonates. Methods A case-control study was conducted on 1 468 neonates with gestational ages ≥34 weeks and

42 completed weeks delivered at the University-Town Hospital of Chongqing Medical University from January 2023 to March 2024. Maternal health parameters and neonatal outcomes were systematically obtained through standardized case report forms during the study period. The neonates were stratified into the hospitalization group and the non-hospitalization group based on neonatal ward admission within 24 h. For those hospitalized with infectious diseases

subgroup analysis was conducted with further categorization into respiratory support and the non-respiratory support subgroups according to ventilatory assistance requirements. The perinatal risk factors were compared between groups and subgroups

and the independent risk factors for hospitalization and the need for respiratory support within 24 h in neonates were identified. The indicators with

0.1 in the univariate analysis were included in the multivariate logistic regression analysis

and the stepwise regression analysis was used to fit the multivariate logistic regression model. Results There were 213 cases (14.5%) in the hospitalization group and 1 255 cases (85.5%) in the non-hospitalization group. A total of 150 neonates were hospitalized due to infectious diseases

including 48 cases (32.0%) in the respiratory support subgroup and 102 cases (68.0%) in the non-respiratory support subgroup. The multivariate logistic regression analysis showed that non-regular maternal prenatal examination (

=2.687

95%

: 1.175~6.141

=0.019)

intrauterine growth retardation (

=2.711

95%

: 1.106~6.646

=0.029)

premature rupture of membranes (

=1.667

95%

: 1.139~2.438

=0.008)

chorioamnionitis (

=4.852

95%

: 2.114~11.135

0.001)

infectious diseases in the first week before delivery (

=1.531

95%

: 1.015~2.310

=0.042)

turbidity of amniotic fluid (

=3.170

95%

: 2.099~4.787

0.001)

abnormal placenta (

=2.335

95%

: 1.202~4.534

=0.012)

complications during pregnancy (

=2.367

95%

: 1.360~4.118

=0.002)

and the use of glucocorticoids before delivery (

=2.744

95%

: 1.219~5.528

=0.009) were positively correlated with hospitalization within 24 h postnatally in late preterm and term neonates. Gestational age (

=0.693

95%

: 0.602~0.797

0.001)

5-minute Apgar score (

=0.026

95%

: 0.003~0.212

=0.001)

umbilical cord blood pH (

=0.044

95%

: 0.002~0.793

=0.034)

and umbilical cord blood BE (

=0.885

95%

: 0.823~0.823

=0.001) were negatively correlated with it. Premature rupture of membranes (

=0.207

95%

: 0.070~0.618

=0.005)

infectious diseases in the first week before delivery (

=0.245

95%

: 0.070~0.854

=0.027)

5-minute Apgar score (

=0.063

95%

: 0.008~0.526

=0.011)

and abnormal C-reactive protein of newborns (

=0.145

95%

: 0.046~0.460

=0.001) were negatively correlated with the need for respiratory support in neonates hospitalized due to infectious diseases.Conclusion‍　‍Risk factors for neonatal hospitalization within 24 h postnatal late preterm and term are identified as irregular antenatal care

fetal growth restriction and premature rupture of membranes in late preterm and term neonates. premature rupture of membranes

antenatal maternal infections within 1 week prior to delivery and 5-minute Apgar score ≥7 emerge as significant protective factors against respiratory support requirement in neonates hospitalized with infectious diseases.

关键词

Keywords

references

邵肖梅，叶鸿瑁，丘小汕 . 实用新生儿学［M］. 5版 . 北京：人民卫生出版社， 2019 ： 57 .

SHAO X M ， YE H M ， QIU X S . Practice of Neonatology ［M］. 5th Edition . Beijing ： People’s Medical Publishing House ， 2019 ： 57 .

SHARMA D ， PADMAVATHI I V ， TABATABAII S A ， et al . Late preterm： a new high risk group in neonatology ［J］. J Matern Fetal Neonatal Med ， 2021 ， 34 （ 16 ）： 2717 - 2730 . DOI： 10.1080/14767058.2019.1670796 http://dx.doi.org/10.1080/14767058.2019.1670796 .

张沂洁，朱燕，陈超 . 早产儿发生率及变化趋势［J］. 中华新生儿科杂志， 2021 ， 36 （ 4 ）： 74 - 77 . DOI： 10.3760/cma.j.issn.2096-2932.2021.04.021 http://dx.doi.org/10.3760/cma.j.issn.2096-2932.2021.04.021 .

ZHANG Y J ， ZHU Y ， CHEN C . Prevalence of preterm infants and trend analysis ［J］. Chin J Neonatol ， 2021 ， 36 （ 4 ）： 74 - 77 . DOI： 10.3760/cma.j.issn.2096-2932.2021.04.021 http://dx.doi.org/10.3760/cma.j.issn.2096-2932.2021.04.021 .

LIU H ， LI J ， GUO J Y ， et al . A prediction nomogram for neonatal acute respiratory distress syndrome in late-preterm infants and full-term infants： a retrospective study ［J］. EClinical Medicine ， 2022 ， 50 ： 101523 . DOI： 10.1016/j.eclinm.2022.101523 http://dx.doi.org/10.1016/j.eclinm.2022.101523 .

OLICKER A L ， RAFFAY T M ， RYAN R M . Neonatal respiratory distress secondary to meconium aspiration syndrome ［J］. Children ， 2021 ， 8 （ 3 ）： 246 . DOI： 10.3390/children8030246 http://dx.doi.org/10.3390/children8030246 .

VENKATESH K K ， JACKSON W ， HUGHES B L ， et al . Association of chorioamnionitis and its duration with neonatal morbidity and mortality ［J］. J Perinatol ， 2019 ， 39 （ 5 ）： 673 - 682 . DOI： 10.1038/s41372-019-0322-0 http://dx.doi.org/10.1038/s41372-019-0322-0 .

CARLHÄLL S ， ALSWEILER J ， BATTIN M ， et al . Neonatal and maternal outcomes at early vs full term following induction of labor： a secondary analysis of the OBLIGE randomized trial ［J］. Acta Obstet Gynecol Scand ， 2024 ， 103 （ 5 ）： 955 - 964 . DOI： 10.1111/aogs.14775 http://dx.doi.org/10.1111/aogs.14775 .

PARIKH L I ， REDDY U M ， MÄNNISTÖ T ， et al . Neonatal outcomes in early term birth ［J］. Am J Obstet Gynecol ， 2014 ， 211 （ 3 ）： 265.e1 - 265265.e11 . DOI： 10.1016/j.ajog. 2014.03.021 http://dx.doi.org/10.1016/j.ajog.2014.03.021 .

LAI J Q ， SU Y X ， YANG Y X ， et al . Standard of recommendation for weight gain during pregnancy period ［J］. Biomed Environ Sci ， 2022 ， 35 （ 10 ）： 875 - 877 . DOI： 10.3967/bes2022.114 http://dx.doi.org/10.3967/bes2022.114 .

廖芳，田美玲，王朔，等 . 妊娠期产前检查次数与低出生体重儿的相关性［J］. 中华疾病控制杂志， 2021 ， 25 （ 10 ）： 1220 - 1225 . DOI： 10.16462/j.cnki.zhjbkz.2021.10.019 http://dx.doi.org/10.16462/j.cnki.zhjbkz.2021.10.019 .

LIAO F ， TIAN M L ， WANG S ， et al . A study on the relationship between the number of prenatal visits and low birth weight infants ［J］. Chin J Dis Contr Prev ， 2021 ， 25 （ 10 ）： 1220 - 1225 . DOI： 10.16462/j.cnki.zhjbkz.2021.10.019 http://dx.doi.org/10.16462/j.cnki.zhjbkz.2021.10.019 .

MCDIEHL R P ， BOATIN A A ， MUGYENYI G R ， et al . Antenatal care visit attendance frequency and birth outcomes in rural Uganda： a prospective cohort study ［J］. Matern Child Health J ， 2021 ， 25 （ 2 ）： 311 - 320 . DOI： 10.1007/s10995-020-03023-0 http://dx.doi.org/10.1007/s10995-020-03023-0 .

BOUNTOGO M ， SIÉ A L ， ZAKANÉ A ， et al . Antenatal care attendance and risk of low birthweight in Burkina Faso： a cross-sectional study ［J］. BMC Pregnancy Childbirth ， 2021 ， 21 （ 1 ）： 825 . DOI： 10.1186/s12884-021-04310-6 http://dx.doi.org/10.1186/s12884-021-04310-6 .

HU W L ， HU H Q ， ZHAO W ， et al . Current status of antenatal care of pregnant women-8 provinces in China， 2018 ［J］. BMC Public Health ， 2021 ， 21 （ 1 ）： 1135 . DOI： 10.1186/s12889-021-11154-4 http://dx.doi.org/10.1186/s12889-021-11154-4 .

侯一珺，谢云，王涛，等 . 283例入住重症监护病房救治的危重孕产妇的临床特征分析［J］. 上海交通大学学报（医学版）， 2021 ， 41 （ 5 ）： 632 - 636 . DOI： 10.3969/j.issn.1674-8115.2021.05.012 http://dx.doi.org/10.3969/j.issn.1674-8115.2021.05.012 .

HOU Y J ， XIE Y ， WANG T ， et al . Analysis of clinical characteristics of 283 maternal near miss admitted to intensive care unit ［J］. J Shanghai Jiaotong Univ Med Sci ， 2021 ， 41 （ 5 ）： 632 - 636 . DOI： 10.3969/j.issn.1674-8115.2021.05.012 http://dx.doi.org/10.3969/j.issn.1674-8115.2021.05.012 .

高伟娜，刘冲，郭书忍，等 . 妊娠合并大动脉炎对母儿结局的影响［J］. 中华妇产科杂志， 2022 ， 57 （ 2 ）： 91 - 100 . DOI： 10.3760/cma.j.cn112141-20210707-00364 http://dx.doi.org/10.3760/cma.j.cn112141-20210707-00364 .

GAO W N ， LIU C ， GUO S R ， et al . Effects of pregnancy complicated with Takayasu arteritis on maternal and fetal outcomes ［J］. Chin J Obstet Gynecol ， 2022 ， 57 （ 2 ）： 91 - 100 . DOI： 10.3760/cma.j.cn112141-20210707-00364 http://dx.doi.org/10.3760/cma.j.cn112141-20210707-00364 .

MELAMED N ， BERGHELLA V ， ANANTH C V ， et al . Optimal timing of labor induction after prelabor rupture of membranes at term： a secondary analysis of the TERMPROM study ［J］. Am J Obstet Gynecol ， 2023 ， 228 （ 3 ）： 326.e1 - 326326.e13 . DOI： 10.1016/j.ajog.2022.09.018 http://dx.doi.org/10.1016/j.ajog.2022.09.018 .

BECK C ， GALLAGHER K ， TAYLOR L A ， et al . Chorioamnionitis and risk for maternal and neonatal sepsis： a systematic review and meta-analysis ［J］. Obstet Gynecol ， 2021 ， 137 （ 6 ）： 1007 - 1022 . DOI： 10.1097/AOG.000000000 0004377 http://dx.doi.org/10.1097/AOG.0000000000004377 .

GOULD A J ， DING J J ， RECABO O ， et al . Risk factors for respiratory distress syndrome among high-risk early-term and full-term deliveries ［J］. J Matern Fetal Neonatal Med ， 2022 ， 35 （ 26 ）： 10401 - 10405 . DOI： 10.1080/14767058. 2022.2128657 http://dx.doi.org/10.1080/14767058.2022.2128657 .

LEE J ， OH K J ， PARK C W ， et al . The presence of funisitis is associated with a decreased risk for the development of neonatal respiratory distress syndrome ［J］. Placenta ， 2011 ， 32 （ 3 ）： 235 - 240 . DOI： 10.1016/j.placenta.2010.11.006 http://dx.doi.org/10.1016/j.placenta.2010.11.006 .

BOHILTEA R E ， CIOCA A M ， DIMA V ， et al . Expectant management of PPROM improves neonatal outcome-a retrospective study of 562 patients ［J］. J Clin Med ， 2021 ， 11 （ 1 ）： 214 . DOI： 10.3390/jcm11010214 http://dx.doi.org/10.3390/jcm11010214 .

ABBAS G ， SHAH S ， HANIF M ， et al . The frequency of pulmonary hypertension in newborn with intrauterine growth restriction ［J］. Sci Rep ， 2020 ， 10 （ 1 ）： 8064 . DOI： 10.1038/s41598-020-65065-2 http://dx.doi.org/10.1038/s41598-020-65065-2 .

CHEN H Y ， BLACKWELL S C ， CHAUHAN S P . Association between apgar score at 5 minutes and adverse outcomes among low-risk pregnancies ［J］. J Matern Fetal Neonatal Med ， 2022 ， 35 （ 7 ）： 1344 - 1351 . DOI： 10.1080/14767058.2020.1754789 http://dx.doi.org/10.1080/14767058.2020.1754789 .

MCGILLICK E V ， ORGEIG S ， GIUSSANI D A ， et al . Chronic hypoxaemia as a molecular regulator of fetal lung development： implications for risk of respiratory complications at birth ［J］. Paediatr Respir Rev ， 2017 ， 21 ： 3 - 10 . DOI： 10.1016/j.prrv.2016.08.011 http://dx.doi.org/10.1016/j.prrv.2016.08.011 .

CHAND S ， SALMAN A ， ABBASSI R M ， et al . Factors leading to meconium aspiration syndrome in term- and post-term neonates ［J］. Cureus ， 2019 ， 11 （ 9 ）： e5574 . DOI： 10.7759/cureus.5574 http://dx.doi.org/10.7759/cureus.5574 .

RAI S ， SOOD M ， KAUR A . Is perinatal asphyxia associated with an increase in serum bilirubin in neonates？A case-control study ［J］. J Family Med Prim Care ， 2022 ， 11 （ 7 ）： 3840 - 3843 . DOI： 10.4103/jfmpc.jfmpc_1018_21 http://dx.doi.org/10.4103/jfmpc.jfmpc_1018_21 .

RUIZ N M ， GARCÍA ÍÑIGUEZ J P ， RITE GRACIA S ， et al . Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late preterm and term infants ［J］. An Pediatr ， 2022 ， 96 （ 3 ）： 230 - 241 . DOI： 10.1016/j.anpede.2021.04.007 http://dx.doi.org/10.1016/j.anpede.2021.04.007 .

SIMON N T ， HAGAN P M ， ROCKHILL K M ， et al . Changes in metabolic acidosis following birth in intensive care unit neonates ［J］. Eur J Obstet Gynecol Reprod Biol ， 2024 ， 297 ： 161 - 168 . DOI： 10.1016/j.ejogrb.2024.04.025 http://dx.doi.org/10.1016/j.ejogrb.2024.04.025 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Progress and prospective of environmental, lifestyle and psychological risk factors for reproductive impairment and adverse birth outcome

Correlation of serum bilirubin with quantitative electroencephalographic parameters in neonatal infants

Efficacy of aortic valve replacement for bicuspid aortic valve: a medium-term follow-up study based on propensity score matching analysis

Prevalence and risk factors of diabetic kidney disease in patients with diabetes in urban and rural communities in Chongqing, China

Different surgical methods for gastrointestinal neuroendocrine tumors: comparison on efficacy and prognosis

Related Author

CAO Jia

CHEN Qing

LI Jieqiong

LI Ying

LI Xin

BAI Lu

BO Tao

LIU Lingchao

Related Institution

Institute of Toxicology, Faculty of Military Preventive Medicine, Army Medical University (Third Military Medical University)

Department of Neonatology, the Third Xiangya Hospital, Central South University

Department of Pediatrics, the First Changsha Hospital

PLA Institute of Cardiovascular Surgery, Second Affiliated Hospital, Army Medical University (Third Military Medical University)

Department of Endocrinology, First Affiliated Hospital, Army Medical University (Third Military Medical University)

⁰