目的探讨新生儿缺氧缺血性脑病(HIE)远期神经功能预后不良危险因素分析及预测评分体系构建。方法选取2018年1月至2020年4月河北北方学院附属第一医院收治的HIE患儿277例,均随访3年,根据是否发生远期神经功能预后不良分为预后良好组(n=2...目的探讨新生儿缺氧缺血性脑病(HIE)远期神经功能预后不良危险因素分析及预测评分体系构建。方法选取2018年1月至2020年4月河北北方学院附属第一医院收治的HIE患儿277例,均随访3年,根据是否发生远期神经功能预后不良分为预后良好组(n=221)和预后不良组(n=56)。采用Logistic分析2组基线资料、实验室指标及影像学资料,获得Logistic预测模型,计算模型方差扩大因子,绘制模型受试者工作特征(ROC)曲线。采用Hosmer-Lemeshow拟合优度检验评价模型的校准能力。采用决策树法分析模型的收益。参考Framingham风险评价模型制定HIE远期神经功能预后评分量表并验证。结果Logistic回归分析结果显示,开始治疗时间(OR=1.108,95%CI:1.015~1.211)、中性粒细胞计数/淋巴细胞计数(NLR)(OR=1.065,95%CI:1.020~1.112)、神经元特异性烯醇化酶(NSE)(OR=1.060,95%CI:1.005~1.117)、扩散加权成像(DWI)值(OR=1.013,95%CI:1.003~1.023)、阻力指数(RI)值(OR=1.269,95%CI:1.017~1.583)、胎盘异常(OR=2.781,95%CI:1.643~4.729)、高乳酸血症(OR=2.563,95%CI:1.487~4.425)、未进行低温治疗(OR=3.980,95%CI:2.356~6.743)是影响HIE远期神经功能预后不良的独立危险因素,而出生5 min Apgar评分(OR=0.864,95%CI:0.750~0.995)是保护因素。预测模型的敏感度为0.9567,特异度为0.8929,准确度为0.9443,曲线下面积(AUC)为0.910(0.722~0.987)。Hosmer-Lemeshow拟合优度检验发现模型具有较好的校准能力(χ^(2)=9.420,P=0.371)。制定HIE远期神经功能预后评分量表,总分39分;量表分为3个等级,即低风险患儿:得分≤14分;中风险患儿:14分<得分≤17分;高风险患儿:得分>17分;经外部验证,评分量表的敏感度为0.8182,特异度为0.8718,准确度为0.8600,AUC为0.813(0.732~0.886)。结论开始治疗时间、NLR、NSE、DWI值、RI值、胎盘异常、高乳酸血症和未进行低温治疗是影响HIE远期神经功能预后不良的独立危险因素,出生5 min Apgar评分是保护因素,构建的评分量表具有一定的远期神经功能预后预测效果。展开更多
目的:探讨3~6月龄早产儿铁缺乏(iron deficiency, ID)状况及影响因素。方法:利用互联网 + 早产儿智慧随访数据库,收集2018年8月~2023年11月有铁蛋白数据的1521例3~6月龄早产儿临床资料,血清铁蛋白浓度 Objective: To explore the status...目的:探讨3~6月龄早产儿铁缺乏(iron deficiency, ID)状况及影响因素。方法:利用互联网 + 早产儿智慧随访数据库,收集2018年8月~2023年11月有铁蛋白数据的1521例3~6月龄早产儿临床资料,血清铁蛋白浓度 Objective: To explore the status and risk factors of iron deficiency (ID) in preterm infants aged 3~6 months. Methods: Using the Internet + Preterm Infant Smart Follow-up Database, clinical data were collected from 1521 preterm infants aged 3~6 months with serum ferritin data from August 2018 to November 2023. Serum ferritin concentration < 12 µg/L was diagnosed as ID. The incidence of iron deficiency in preterm infants of varying gestational ages is examined. Risk factors of ID were investigated by using univariate and logistic regression analysis. Results: The incidence of ID in preterm infants aged 3~6 months was 14.40% (219/1521), The incidence of ID in early, middle and late preterm infants was 12.37% (35/283), 19.64% (54/275) and 13.50% (130/963) respectively. The proportions of males, moderately preterm infants, and exclusive breastfeeding were higher in the ID group than in the control group (all P < 0.05). The proportions of first birth, iron supplementation, and vitamin D supplementation were lower than those in the control group (all P< 0.05). Hemoglobin levels before discharge in the neonatal period in the ID group were lower than in the control group (P < 0.05). Logistics regression analysis showed that moderately preterm infants, non-1st birth, males, lower hemoglobin value before discharge, no iron supplementation, and exclusive breastfeeding at the time of testing were risk factors for ID (OR= 1.825, 1.540, 2.098, 0.974, 1.567, and 6.605, all P < 0.05). Conclusions: Targeted iron supplementation education should be performed for male, non first birth preterm infants with exclusive breastfeeding after discharge and moderately preterm infants.展开更多
文摘目的探讨新生儿缺氧缺血性脑病(HIE)远期神经功能预后不良危险因素分析及预测评分体系构建。方法选取2018年1月至2020年4月河北北方学院附属第一医院收治的HIE患儿277例,均随访3年,根据是否发生远期神经功能预后不良分为预后良好组(n=221)和预后不良组(n=56)。采用Logistic分析2组基线资料、实验室指标及影像学资料,获得Logistic预测模型,计算模型方差扩大因子,绘制模型受试者工作特征(ROC)曲线。采用Hosmer-Lemeshow拟合优度检验评价模型的校准能力。采用决策树法分析模型的收益。参考Framingham风险评价模型制定HIE远期神经功能预后评分量表并验证。结果Logistic回归分析结果显示,开始治疗时间(OR=1.108,95%CI:1.015~1.211)、中性粒细胞计数/淋巴细胞计数(NLR)(OR=1.065,95%CI:1.020~1.112)、神经元特异性烯醇化酶(NSE)(OR=1.060,95%CI:1.005~1.117)、扩散加权成像(DWI)值(OR=1.013,95%CI:1.003~1.023)、阻力指数(RI)值(OR=1.269,95%CI:1.017~1.583)、胎盘异常(OR=2.781,95%CI:1.643~4.729)、高乳酸血症(OR=2.563,95%CI:1.487~4.425)、未进行低温治疗(OR=3.980,95%CI:2.356~6.743)是影响HIE远期神经功能预后不良的独立危险因素,而出生5 min Apgar评分(OR=0.864,95%CI:0.750~0.995)是保护因素。预测模型的敏感度为0.9567,特异度为0.8929,准确度为0.9443,曲线下面积(AUC)为0.910(0.722~0.987)。Hosmer-Lemeshow拟合优度检验发现模型具有较好的校准能力(χ^(2)=9.420,P=0.371)。制定HIE远期神经功能预后评分量表,总分39分;量表分为3个等级,即低风险患儿:得分≤14分;中风险患儿:14分<得分≤17分;高风险患儿:得分>17分;经外部验证,评分量表的敏感度为0.8182,特异度为0.8718,准确度为0.8600,AUC为0.813(0.732~0.886)。结论开始治疗时间、NLR、NSE、DWI值、RI值、胎盘异常、高乳酸血症和未进行低温治疗是影响HIE远期神经功能预后不良的独立危险因素,出生5 min Apgar评分是保护因素,构建的评分量表具有一定的远期神经功能预后预测效果。
文摘目的:探讨3~6月龄早产儿铁缺乏(iron deficiency, ID)状况及影响因素。方法:利用互联网 + 早产儿智慧随访数据库,收集2018年8月~2023年11月有铁蛋白数据的1521例3~6月龄早产儿临床资料,血清铁蛋白浓度 Objective: To explore the status and risk factors of iron deficiency (ID) in preterm infants aged 3~6 months. Methods: Using the Internet + Preterm Infant Smart Follow-up Database, clinical data were collected from 1521 preterm infants aged 3~6 months with serum ferritin data from August 2018 to November 2023. Serum ferritin concentration < 12 µg/L was diagnosed as ID. The incidence of iron deficiency in preterm infants of varying gestational ages is examined. Risk factors of ID were investigated by using univariate and logistic regression analysis. Results: The incidence of ID in preterm infants aged 3~6 months was 14.40% (219/1521), The incidence of ID in early, middle and late preterm infants was 12.37% (35/283), 19.64% (54/275) and 13.50% (130/963) respectively. The proportions of males, moderately preterm infants, and exclusive breastfeeding were higher in the ID group than in the control group (all P < 0.05). The proportions of first birth, iron supplementation, and vitamin D supplementation were lower than those in the control group (all P< 0.05). Hemoglobin levels before discharge in the neonatal period in the ID group were lower than in the control group (P < 0.05). Logistics regression analysis showed that moderately preterm infants, non-1st birth, males, lower hemoglobin value before discharge, no iron supplementation, and exclusive breastfeeding at the time of testing were risk factors for ID (OR= 1.825, 1.540, 2.098, 0.974, 1.567, and 6.605, all P < 0.05). Conclusions: Targeted iron supplementation education should be performed for male, non first birth preterm infants with exclusive breastfeeding after discharge and moderately preterm infants.
