摘要
目的基于新生儿重症监护室(neonatal intensive care unit,NICU)的多中心数据,进行胎龄<28周超早产儿(extremely preterm infants,EPIs)纵向宫外生长迟缓(extrauterine growth restriction,EUGR)现状调查,并建立预测模型。方法回顾性研究2017年1月至2018年12月华北地区32个NICU收治的EPIs一般情况、营养支持、住院期间并发症及体重增长情况等临床资料。出院体重Z评分较入院时下降>1定义为纵向EUGR,将EPIs分为纵向EUGR组及非纵向EUGR组,总结EPIs营养支持及体重增长现状。将EPIs按7∶3的比例随机分为训练集和验证集。在训练集中采用单因素和多因素回归分析筛选纵向EUGR的独立危险因素,利用赤池信息准则决定最优Nomogram模型并绘制列线图。对模型进行区分度、校准度和临床决策曲线评价。结果共纳入436例EPIs,胎龄(26.9±0.9)周,出生体重(989±171)g,纵向RUGR发生率82.3%(359/436)。最终纳入出生体重Z评分、体重下降程度、体重增长速率、出院前3 d母乳喂养比例≥75%、机械通气≥7 d、母亲完成产前促肺治疗、支气管肺发育不良7个变量构建列线图。训练集和验证集的受试者工作特征曲线下面积分别为0.870(95%CI 0.820~0.920)和0.879(95%CI 0.815~0.942),提示模型区分度良好。校准曲线提示模型存在较好的拟合度(P>0.05)。临床决策曲线分析表明模型在所有阈值下均有正向获益。结论目前EPIs纵向ERGR发生率较高,本研究构建并验证了EPIs出院时纵向EUGR的预测模型,有助于尽早识别纵向EUGR高危的EPIs并进行干预。未来研究有必要扩大样本量和进行前瞻性研究来优化和验证该预测模型。
Objective To study the current status of longitudinal extrauterine growth restriction(EUGR)in extremely preterm infants(EPIs)and to develop a prediction model based on clinical data from multiple NICUs.Methods From January 2017 to December 2018,EPIs admitted to 32 NICUs in North China were retrospectively studied.Their general conditions,nutritional support,complications during hospitalization and weight changes were reviewed.Weight loss between birth and discharge>1SD was defined as longitudinal EUGR.The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared.The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3.Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors.The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion.The model was evaluated for discrimination efficacy,calibration and clinical decision curve analysis.Results A total of 436 EPIs were included in this study,with a mean gestational age of(26.9±0.9)weeks and a birth weight of(989±171)g.The incidence of longitudinal EUGR was 82.3%(359/436).Seven variables(birth weight Z-score,weight loss,weight growth velocity,the proportion of breast milk≥75%within 3 d before discharge,invasive mechanical ventilation≥7 d,maternal antenatal corticosteroids use and bronchopulmonary dysplasia)were selected to establish the prediction model.The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870(95%CI 0.820-0.920)and 0.879(95%CI 0.815-0.942),suggesting good discrimination efficacy.The calibration curve indicated a good fit of the model(P>0.05).The decision curve analysis showed positive net benefits at all thresholds.Conclusions Currently,EPIs have a high incidence of longitudinal EUGR.The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR.It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.
作者
黄晓芳
冯琪
李帅军
田秀英
冀湧
周颖
田渤
李月梅
郭玮
翟淑芬
何海英
刘霞
郑荣秀
樊沙沙
马莉
王红云
王晓颖
黄山雅美
李巾宇
谢华
李晓香
张平平
梅花
胡艳菊
杨明
陈璐
李亚静
谷晓虹
阙生顺
闫小仙
王海娟
孙丽霞
张亮
郭九叶
Huang Xiaofang;Feng Qi;Li Shuaijun;Tian Xiuying;Ji Yong;Zhou Ying;Tian Bo;Li Yuemei;Guo Wei;Zhai Shufen;He Haiying;Liu Xia;Zheng Rongxiu;Fan Shasha;Ma Li;Wang Hongyun;Wang Xiaoying;Huang Shanyamei;Li Jinyu;Xie Hua;Li Xiaoxiang;Zhang Pingping;Mei Hua;Hu Yanju;Yang Ming;Chen Lu;Li Yajing;Gu Xiaohong;Que Shengshun;Yan Xiaoxian;Wang Haijuan;Sun Lixia;Zhang Liang;Guo Jiuye(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China;Department of Maternal and Child Health,School of Public Health,Peking University,Beijing 100191,China;Department of Neonatology,Tianjin Central Hospital of Obstetrics and Gynecology,Tianjin 300100,China;Department of Pediatrics,Shanxi Children's Hospital,Taiyuan 030013,China;Department of Pediatrics,Peking University Third Hospital,Beijing 100191,China;Department of Pediatrics,Tangshan Maternal and Child Health Hospital,Tangshan 063000,China;Department of Pediatrics,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Pediatrics,Xingtai People's Hospital,Xingtai 054031,China;Department of Pediatrics,Handan Central Hospital,Handan 056000,China;Department of Pediatrics,Baogang Third Hospital of Hongci Group,Baotou 014010,China;Department of Pediatrics,Affiliated Hospital of Chengde Medical College,Chengde 067000,China;Department of Pediatrics,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Pediatrics,the First Hospital of Tsinghua University,Beijing 100016,China;Department of Pediatrics,Hebei Children's Hospital,Shijiazhuang 050031,China;Department of Pediatrics,Inner Mongolia Maternal and Child Health Hospital,Hohhot 010020,China;Department of Neonatology,Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Department of Pediatrics,Peking University People's Hospital,Beijing 100044,China;Department of Pediatrics,Peking Union Medical College Hospital,Beijing 100730,China;Department of Pediatrics,Affiliated Hospital of Chifeng University,Chifeng 024000,China;Department of Pediatrics,Beijing Luhe Hospital,Capital Medical University,Beijing101100,China;Department of Neonatology,Tianjin First Center Hospital,Tianjin 300190,China;Departmentof Pediatrics,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China;Department of Pediatrics,Xing'an League People's Hospital,Ulanhot 137400,China;Department of Pediatrics,Beijing United Family Hospital,Beijing100015,China;Department of Neonatology,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;Department of Pediatrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Pediatrics,Zhangjiakou Maternal and Child Health Hospital,Zhangjiakou 075000,China;Department of Pediatrics,the Second Hospital of Tianjin Medical University,Tianjin 300211,China;Department of Pediatrics,Fenyang College of Shanxi Medical University,Fenyang 032200,China;Department of Pediatrics,Baoding Maternal and Child Health Hospital,Baoding 071000,China;Department of Pediatrics,Taiyuan Maternal and Infant Health Care Hospital of Shanxi Province,Taiyuan 030012,China;Department of Pediatrics,Chifeng Municipal Hospital,Chifeng 024000,China;Department of Pediatrics,Chaoyang Maternal and Child Health Hospital of Beijing,Beijing 100020,China)
出处
《中华新生儿科杂志（中英文）》
CAS
CSCD
2024年第3期136-144,共9页
Chinese Journal of Neonatology
关键词
纵向
宫外生长迟缓
现状
预测模型
超早产儿
Longitudinal
Extrauterine growth restriction
Current status
Prediction model
Extremely preterm infants
