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Article(id=1322934655401472176, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322934653228822704, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202408040, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1723392000000, receivedDateStr=2024-08-12, revisedDate=1736265600000, revisedDateStr=2025-01-08, acceptedDate=null, acceptedDateStr=null, onlineDate=1793341800785, onlineDateStr=2026-10-30, pubDate=1741968000000, pubDateStr=2025-03-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793341800785, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793341800785, creator=13701087609, updateTime=1793341800785, updator=13701087609, issue=Issue{id=1322934653228822704, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='5', pageStart='385', pageEnd='488', issueExtLink='null', onlineDate='null', pubDate='1741968000000', pubDateStr='2025-03-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793341800267, creator='13701087609', updateTime=1793341800267, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=472, endPage=479, ext={EN=ArticleExt(id=1322934655640547505, articleId=1322934655401472176, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Risk factors for hospitalization within 24 h postnatally and respiratory support in late preterm and term neonates, columnId=1320435174995772212, journalTitle=Journal of Army Medical University, columnName=Clinical Medicine, runingTitle=null, highlight=null, articleAbstract=
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 P<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 (OR=2.687, 95%CI: 1.175~6.141, P=0.019), intrauterine growth retardation (OR=2.711, 95%CI: 1.106~6.646, P=0.029), premature rupture of membranes (OR=1.667, 95%CI: 1.139~2.438, P=0.008), chorioamnionitis (OR=4.852, 95%CI: 2.114~11.135, P<0.001), infectious diseases in the first week before delivery (OR=1.531, 95%CI: 1.015~2.310, P=0.042), turbidity of amniotic fluid (OR=3.170, 95%CI: 2.099~4.787, P<0.001), abnormal placenta (OR=2.335, 95%CI: 1.202~4.534, P=0.012), complications during pregnancy (OR=2.367, 95%CI: 1.360~4.118, P=0.002), and the use of glucocorticoids before delivery (OR=2.744, 95%CI: 1.219~5.528, P=0.009) were positively correlated with hospitalization within 24 h postnatally in late preterm and term neonates. Gestational age (OR=0.693, 95%CI: 0.602~0.797, P<0.001), 5-minute Apgar score (OR=0.026, 95%CI: 0.003~0.212, P=0.001), umbilical cord blood pH (OR=0.044, 95%CI: 0.002~0.793, P=0.034), and umbilical cord blood BE (OR=0.885, 95%CI: 0.823~0.823, P=0.001) were negatively correlated with it. Premature rupture of membranes (OR=0.207, 95%CI: 0.070~0.618, P=0.005), infectious diseases in the first week before delivery (OR=0.245, 95%CI: 0.070~0.854, P=0.027), 5-minute Apgar score (OR=0.063, 95%CI: 0.008~0.526, P=0.011), and abnormal C-reactive protein of newborns (OR=0.145, 95%CI: 0.046~0.460, P=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.

, authors=Shuqing TANG1, Li WANG2, Lu PENG2, Hui LIU1, 2, authorsList=Shuqing TANG, Li WANG, Lu PENG, Hui LIU, authorCompany=null, correspAuthors=Hui LIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2025 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322934656093532338, articleId=1322934655401472176, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=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, columnId=1322185541475488183, journalTitle=陆军军医大学学报, columnName=临床医学, runingTitle=null, highlight=null, articleAbstract=
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P<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%CI：1.175~6.141，P=0.019）、胎儿宫内发育迟缓（OR=2.711，95%CI：1.106~6.646，P=0.029）、胎膜早破（OR=1.667，95%CI：1.139~2.438，P=0.008）、绒毛膜羊膜炎（OR=4.852，95%CI：2.114~11.135，P<0.001）、产前1周患感染性疾病（OR=1.531，95%CI：1.015~2.310，P=0.042）、羊水浑浊（OR=3.170，95%CI：2.099~4.787，P<0.001）、胎盘异常（OR=2.335，95%CI：1.202~4.534，P=0.012）、妊娠期其他并发症（OR=2.367，95%CI：1.360~4.118，P=0.002）、产前应用糖皮质激素（OR=2.744，95%CI：1.219~5.528，P=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%CI：0.602~0.797，P<0.001）、Apgar 5分钟评分（OR=0.026，95%CI：0.003~0.212，P=0.001）、脐血pH（OR=0.044，95%CI：0.002~0.793，P=0.034）、脐血BE（OR=0.885，95%CI：0.823~0.823，P=0.001）与其呈负相关。胎膜早破（OR=0.207，95%CI：0.070~0.618，P=0.005）、产前1周患感染性疾病（OR=0.245，95%CI：0.070~0.854，P=0.027）、Apgar 5分钟评分（OR=0.063，95%CI：0.008~0.526，P=0.011）、新生儿C反应蛋白异常（OR=0.145，95%CI：0.046~0.460，P=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。

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刘慧，E-mail：
LIU Hui，E-mail：
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Eur J Obstet Gynecol Reprod Biol，2024，297：161-168., articleTitle=Changes in metabolic acidosis following birth in intensive care unit neonates, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322934656349384883, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, xref=1, ext=[AuthorCompanyExt(id=1322934656357773492, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, companyId=1322934656349384883, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Pediatrics，University-Town Hospital of Chongqing Medical University，Chongqing), AuthorCompanyExt(id=1322934656366162101, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, companyId=1322934656349384883, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1重庆医科大学附属大学城医院儿科，重庆)]), AuthorCompany(id=1322934656445853878, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, xref=2, ext=[AuthorCompanyExt(id=1322934656462631095, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, companyId=1322934656445853878, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Pediatrics，the Second Affiliated Hospital of Chongqing Medical University，Chongqing，China), AuthorCompanyExt(id=1322934656471019704, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, companyId=1322934656445853878, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2重庆医科大学附属第二医院儿科，重庆)])], figs=[ArticleFig(id=1322934660740821208, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标住院组（n=213）非住院组（n=1 255）χ2/tP
高危年龄a23（10.8）165（13.1）0.9000.343
初中及以下学历25（11.7）108（8.6）2.1670.141
有工作134（62.9）859（68.4）2.5490.110
妊娠前基础疾病27（12.7）128（10.2）1.1830.277
孕前BMI（kg/m2）
<18.525（11.7）161（12.8）1.2530.740
18.5~<24144（67.6）871（69.4）
24~<2834（16.0）178（14.2）
≥2810（4.7）45（3.6）
孕期体质量增长
增长不足19（8.9）117（9.3）0.1990.905
增长适宜98（46.0）557（44.4）
增长过度96（45.1）581（46.3）
吸烟/饮酒/吸毒2（0.9）6（0.5）1.2890.525
未正规产检10（4.7）26（2.1）5.2380.022
胚胎移植10（4.7）24（1.9）6.2310.023
双胎/多胎11（5.2）19（1.5）12.1210.002
既往剖宫产史37（17.4）222（17.7）0.0130.910
剖宫产97（45.5）638（50.8）2.0440.153
IUGR10（4.7）19（1.5）9.5150.005
先兆早产23（10.8）53（4.2）16.036<0.001
PROM60（28.2）222（17.7）12.886<0.001
CA18（8.5）17（1.4）39.398<0.001
产前1周患感染性疾病47（22.1）177（14.1）8.9280.003
胎儿宫内窘迫33（15.5）89（7.1）16.867<0.001
羊水浑浊52（24.4）148（11.8）24.646<0.001
羊水量异常15（7.0）114（9.1）0.9470.331
脐带异常71（33.3）400（31.9）0.1780.673
胎盘异常19（8.9）43（3.4）13.587<0.001
ICP7（3.3）50（4.0）0.2370.626
GDM65（30.5）366（29.2）0.1610.688
HDP28（13.1）93（7.4）7.9190.005
妊娠期甲状腺功能异常47（22.1）231（18.4）1.5880.208
妊娠期贫血8（3.8）42（3.3）0.0930.761
妊娠期其他并发症24（11.3）66（5.3）11.4240.001
产前应用糖皮质激素23（10.8）25（2.0）44.646<0.001
产前WBC/（×109/L）9.01±2.338.74±2.161.6990.090
产前PLT/（×109/L）191.00±52.17201.50±56.10-2.5540.011
产前HB（g/L）126.45±70.59126.02±50.720.1070.915
胎龄/周38.50±1.7439.15±1.13-5.235<0.001
出生体质量/g3 129.04±533.253 289.44±398.26-4.196<0.001
Apgar 5分钟评分/分9.86±0.5410.00±0.03-3.786<0.001
脐血pH7.28±0.097.31±0.06-5.281<0.001
脐血BE/（mmol/L）-5.16±3.95-3.57±2.43-5.692<0.001
脐血Lac/（mmol/L）4.24±3.023.14±1.785.134<0.001
a：母亲妊娠期高危年龄为<20岁或≥35岁
), ArticleFig(id=1322934660984090841, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, language=CN, label=表1, caption=

住院组与非住院组母亲及新生儿的临床资料比较［例（%），x¯±s］

, figureFileSmall=null, figureFileBig=null, tableContent=
指标住院组（n=213）非住院组（n=1 255）χ2/tP
高危年龄a23（10.8）165（13.1）0.9000.343
初中及以下学历25（11.7）108（8.6）2.1670.141
有工作134（62.9）859（68.4）2.5490.110
妊娠前基础疾病27（12.7）128（10.2）1.1830.277
孕前BMI（kg/m2）
<18.525（11.7）161（12.8）1.2530.740
18.5~<24144（67.6）871（69.4）
24~<2834（16.0）178（14.2）
≥2810（4.7）45（3.6）
孕期体质量增长
增长不足19（8.9）117（9.3）0.1990.905
增长适宜98（46.0）557（44.4）
增长过度96（45.1）581（46.3）
吸烟/饮酒/吸毒2（0.9）6（0.5）1.2890.525
未正规产检10（4.7）26（2.1）5.2380.022
胚胎移植10（4.7）24（1.9）6.2310.023
双胎/多胎11（5.2）19（1.5）12.1210.002
既往剖宫产史37（17.4）222（17.7）0.0130.910
剖宫产97（45.5）638（50.8）2.0440.153
IUGR10（4.7）19（1.5）9.5150.005
先兆早产23（10.8）53（4.2）16.036<0.001
PROM60（28.2）222（17.7）12.886<0.001
CA18（8.5）17（1.4）39.398<0.001
产前1周患感染性疾病47（22.1）177（14.1）8.9280.003
胎儿宫内窘迫33（15.5）89（7.1）16.867<0.001
羊水浑浊52（24.4）148（11.8）24.646<0.001
羊水量异常15（7.0）114（9.1）0.9470.331
脐带异常71（33.3）400（31.9）0.1780.673
胎盘异常19（8.9）43（3.4）13.587<0.001
ICP7（3.3）50（4.0）0.2370.626
GDM65（30.5）366（29.2）0.1610.688
HDP28（13.1）93（7.4）7.9190.005
妊娠期甲状腺功能异常47（22.1）231（18.4）1.5880.208
妊娠期贫血8（3.8）42（3.3）0.0930.761
妊娠期其他并发症24（11.3）66（5.3）11.4240.001
产前应用糖皮质激素23（10.8）25（2.0）44.646<0.001
产前WBC/（×109/L）9.01±2.338.74±2.161.6990.090
产前PLT/（×109/L）191.00±52.17201.50±56.10-2.5540.011
产前HB（g/L）126.45±70.59126.02±50.720.1070.915
胎龄/周38.50±1.7439.15±1.13-5.235<0.001
出生体质量/g3 129.04±533.253 289.44±398.26-4.196<0.001
Apgar 5分钟评分/分9.86±0.5410.00±0.03-3.786<0.001
脐血pH7.28±0.097.31±0.06-5.281<0.001
脐血BE/（mmol/L）-5.16±3.95-3.57±2.43-5.692<0.001
脐血Lac/（mmol/L）4.24±3.023.14±1.785.134<0.001
a：母亲妊娠期高危年龄为<20岁或≥35岁
), ArticleFig(id=1322934661185417434, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标呼吸支持治疗组（n=48）无呼吸支持治疗组（n=102）χ2/tP
高危年龄a5（10.4）8（7.8）0.2730.601
初中及以下学历8（16.7）11（10.8）1.0210.312
有工作28（58.3）66（64.7）0.5670.452
妊娠前基础疾病6（12.5）12（11.8）0.0170.897
孕前BMI（kg/m2）
<18.53（6.3）12（11.8）3.8490.278
18.5~<2438（79.2）70（68.6）
24~<287（14.6）15（14.7）
≥2805（4.9）
孕期体质量增长
增长不足3（6.3）7（6.9）0.1080.947
增长适宜23（47.9）46（45.1）
增长过度22（45.8）49（48.0）
母亲吸烟/饮酒/吸毒00--
未正规产检4（8.3）6（5.9）0.3150.727
胚胎移植2（4.2）2（2.0）0.6120.434
双胎/多胎4（8.3）2（2.0）3.4520.083
既往剖宫产史12（25.0）14（13.7）2.8960.089
剖宫产23（47.9）31（30.4）4.3510.037
IUGR03（2.9）1.4410.552
先兆早产4（8.3）8（7.8）0.0111.000
PROM6（12.5）38（37.3）9.6490.002
CA8（16.7）8（7.8）2.6670.102
产前1周患感染性疾病6（12.5）30（29.4）5.1180.024
胎儿宫内窘迫8（16.7）16（15.7）0.0230.879
羊水浑浊10（20.8）32（31.4）1.7980.180
羊水量异常8（16.7）3（2.9）9.0490.005
脐带异常12（25.0）39（38.2）2.5480.110
胎盘异常4（8.3）4（3.9）1.2580.268
ICP3（6.3）1（1.0）3.4920.097
GDM12（25.0）32（31.4）0.6390.424
HDP4（8.3）8（7.8）0.0111.000
妊娠期甲状腺功能异常12（25.0）19（18.6）0.8080.369
妊娠期贫血04（3.9）1.9340.306
妊娠期其他并发症4（8.3）10（9.8）0.0831.000
产前应用糖皮质激素6（12.5）5（4.9）2.7730.107
产前WBC/（×109/L）8.85±2.359.11±2.40-0.6200.536
产前PLT/（×109/L）175.77±58.33193.43±53.54-1.8310.069
产前HB/（g/L）120.46±10.28121.73±12.20-0.6230.534
胎龄/周38.36±2.02338.94±1.49-1.7790.079
出生体质量/g3 096.46±574.633 209.07±467.98-1.2760.204
Apgar 5分钟评分/分9.48±0.999.99±0.10-3.5710.001
脐血pH7.24±0.127.29±0.07-3.0870.003
脐血BE/（mmol/L）-6.93±5.01-4.81±3.24-2.6680.010
脐血Lac/（mmol/L）5.25±3.704.00±2.242.1620.034
新生儿WBC/（×109/L）16.62±7.6119.63±5.78-2.4330.017
新生儿PLT/（×109/L）266.60±59.80271.07±73.62-0.3670.714
新生儿HB/（g/L）169.54±18.00171.46±23.48-0.5010.617
新生儿CRP异常4（8.3）43（42.2）17.355<0.001
a：母亲妊娠期高危年龄为<20岁或≥35岁
), ArticleFig(id=1322934661323829467, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, language=CN, label=表2, caption=

呼吸支持治疗组与无呼吸支持治疗组母亲及新生儿临床资料比较［例（%），x¯±s］

, figureFileSmall=null, figureFileBig=null, tableContent=
指标呼吸支持治疗组（n=48）无呼吸支持治疗组（n=102）χ2/tP
高危年龄a5（10.4）8（7.8）0.2730.601
初中及以下学历8（16.7）11（10.8）1.0210.312
有工作28（58.3）66（64.7）0.5670.452
妊娠前基础疾病6（12.5）12（11.8）0.0170.897
孕前BMI（kg/m2）
<18.53（6.3）12（11.8）3.8490.278
18.5~<2438（79.2）70（68.6）
24~<287（14.6）15（14.7）
≥2805（4.9）
孕期体质量增长
增长不足3（6.3）7（6.9）0.1080.947
增长适宜23（47.9）46（45.1）
增长过度22（45.8）49（48.0）
母亲吸烟/饮酒/吸毒00--
未正规产检4（8.3）6（5.9）0.3150.727
胚胎移植2（4.2）2（2.0）0.6120.434
双胎/多胎4（8.3）2（2.0）3.4520.083
既往剖宫产史12（25.0）14（13.7）2.8960.089
剖宫产23（47.9）31（30.4）4.3510.037
IUGR03（2.9）1.4410.552
先兆早产4（8.3）8（7.8）0.0111.000
PROM6（12.5）38（37.3）9.6490.002
CA8（16.7）8（7.8）2.6670.102
产前1周患感染性疾病6（12.5）30（29.4）5.1180.024
胎儿宫内窘迫8（16.7）16（15.7）0.0230.879
羊水浑浊10（20.8）32（31.4）1.7980.180
羊水量异常8（16.7）3（2.9）9.0490.005
脐带异常12（25.0）39（38.2）2.5480.110
胎盘异常4（8.3）4（3.9）1.2580.268
ICP3（6.3）1（1.0）3.4920.097
GDM12（25.0）32（31.4）0.6390.424
HDP4（8.3）8（7.8）0.0111.000
妊娠期甲状腺功能异常12（25.0）19（18.6）0.8080.369
妊娠期贫血04（3.9）1.9340.306
妊娠期其他并发症4（8.3）10（9.8）0.0831.000
产前应用糖皮质激素6（12.5）5（4.9）2.7730.107
产前WBC/（×109/L）8.85±2.359.11±2.40-0.6200.536
产前PLT/（×109/L）175.77±58.33193.43±53.54-1.8310.069
产前HB/（g/L）120.46±10.28121.73±12.20-0.6230.534
胎龄/周38.36±2.02338.94±1.49-1.7790.079
出生体质量/g3 096.46±574.633 209.07±467.98-1.2760.204
Apgar 5分钟评分/分9.48±0.999.99±0.10-3.5710.001
脐血pH7.24±0.127.29±0.07-3.0870.003
脐血BE/（mmol/L）-6.93±5.01-4.81±3.24-2.6680.010
脐血Lac/（mmol/L）5.25±3.704.00±2.242.1620.034
新生儿WBC/（×109/L）16.62±7.6119.63±5.78-2.4330.017
新生儿PLT/（×109/L）266.60±59.80271.07±73.62-0.3670.714
新生儿HB/（g/L）169.54±18.00171.46±23.48-0.5010.617
新生儿CRP异常4（8.3）43（42.2）17.355<0.001
a：母亲妊娠期高危年龄为<20岁或≥35岁
), ArticleFig(id=1322934661462241500, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标BSEWald χ2POR95%CI
未正规产检0.9880.4225.4910.0192.6871.175~6.141
IUGR0.9970.4584.7520.0292.7111.106~6.646
PROM0.5110.1946.9300.0081.6671.139~2.438
CA1.5790.42413.882<0.0014.8522.114~11.135
产前1周患感染性疾病0.4260.2104.1280.0421.5311.015~2.310
羊水浑浊1.1540.21030.073<0.0013.1702.099~4.787
胎盘异常0.8480.3396.2700.0122.3351.202~4.534
妊娠期其他并发症0.8620.2839.2980.0022.3671.360~4.118
产前应用糖皮质激素1.0090.3846.9020.0092.7441.219~5.528
胎龄-0.3670.07126.388<0.0010.6930.602~0.797
Apgar 5分钟评分-3.6651.07911.5270.0010.0260.003~0.212
脐血pH-3.1261.4774.4820.0340.0440.002~0.793
脐血BE-0.1220.03710.9580.0010.8850.823~0.823
常量70.67115.47320.860<0.0014.922E+30
), ArticleFig(id=1322934661550321885, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, language=CN, label=表3, caption=

近足月及足月新生儿出生后24 h内住院风险多因素Logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
指标BSEWald χ2POR95%CI
未正规产检0.9880.4225.4910.0192.6871.175~6.141
IUGR0.9970.4584.7520.0292.7111.106~6.646
PROM0.5110.1946.9300.0081.6671.139~2.438
CA1.5790.42413.882<0.0014.8522.114~11.135
产前1周患感染性疾病0.4260.2104.1280.0421.5311.015~2.310
羊水浑浊1.1540.21030.073<0.0013.1702.099~4.787
胎盘异常0.8480.3396.2700.0122.3351.202~4.534
妊娠期其他并发症0.8620.2839.2980.0022.3671.360~4.118
产前应用糖皮质激素1.0090.3846.9020.0092.7441.219~5.528
胎龄-0.3670.07126.388<0.0010.6930.602~0.797
Apgar 5分钟评分-3.6651.07911.5270.0010.0260.003~0.212
脐血pH-3.1261.4774.4820.0340.0440.002~0.793
脐血BE-0.1220.03710.9580.0010.8850.823~0.823
常量70.67115.47320.860<0.0014.922E+30
), ArticleFig(id=1322934661676151006, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标BSEWald χ2POR95%CI
PROM-1.5730.5577.9760.0050.2070.070~0.618
产前1周患感染性疾病-1.4070.6384.8730.0270.2450.070~0.854
Apgar 5分钟评分-2.7671.0846.5180.0110.0630.008~0.526
新生儿CRP异常-1.9320.59010.7370.0010.1450.046~0.460
常量29.63510.7887.5460.0067.417E+12
), ArticleFig(id=1322934661776814303, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322934655401472176, language=CN, label=表4, caption=

近足月及足月新生儿出生后24 h内需呼吸支持治疗风险的多因素Logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
指标BSEWald χ2POR95%CI
PROM-1.5730.5577.9760.0050.2070.070~0.618
产前1周患感染性疾病-1.4070.6384.8730.0270.2450.070~0.854
Apgar 5分钟评分-2.7671.0846.5180.0110.0630.008~0.526
新生儿CRP异常-1.9320.59010.7370.0010.1450.046~0.460
常量29.63510.7887.5460.0067.417E+12
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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
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唐书庆 1 , 汪丽 2 , 彭露 2 , 刘慧 1, 2
陆军军医大学学报 | 临床医学 2025,47(5): 472-479
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陆军军医大学学报 |临床医学 2025 , 47 (5) : 472 -479
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
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唐书庆1, 汪丽2, 彭露2, 刘慧1, 2
作者信息
  • 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
通讯作者:
刘慧，E-mail：
LIU Hui，E-mail：
Risk factors for hospitalization within 24 h postnatally and respiratory support in late preterm and term neonates
Shuqing TANG1, Li WANG2, Lu PENG2, Hui LIU1, 2
Affiliations
  • 1Department of Pediatrics，University-Town Hospital of Chongqing Medical University，Chongqing
  • 2Department of Pediatrics，the Second Affiliated Hospital of Chongqing Medical University，Chongqing，China
出版时间: 2025-03-15 doi: 10.16016/j.2097-0927.202408040
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摘要
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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P<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%CI：1.175~6.141，P=0.019）、胎儿宫内发育迟缓（OR=2.711，95%CI：1.106~6.646，P=0.029）、胎膜早破（OR=1.667，95%CI：1.139~2.438，P=0.008）、绒毛膜羊膜炎（OR=4.852，95%CI：2.114~11.135，P<0.001）、产前1周患感染性疾病（OR=1.531，95%CI：1.015~2.310，P=0.042）、羊水浑浊（OR=3.170，95%CI：2.099~4.787，P<0.001）、胎盘异常（OR=2.335，95%CI：1.202~4.534，P=0.012）、妊娠期其他并发症（OR=2.367，95%CI：1.360~4.118，P=0.002）、产前应用糖皮质激素（OR=2.744，95%CI：1.219~5.528，P=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%CI：0.602~0.797，P<0.001）、Apgar 5分钟评分（OR=0.026，95%CI：0.003~0.212，P=0.001）、脐血pH（OR=0.044，95%CI：0.002~0.793，P=0.034）、脐血BE（OR=0.885，95%CI：0.823~0.823，P=0.001）与其呈负相关。胎膜早破（OR=0.207，95%CI：0.070~0.618，P=0.005）、产前1周患感染性疾病（OR=0.245，95%CI：0.070~0.854，P=0.027）、Apgar 5分钟评分（OR=0.063，95%CI：0.008~0.526，P=0.011）、新生儿C反应蛋白异常（OR=0.145，95%CI：0.046~0.460，P=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。

围产期  /  危险因素  /  新生儿  /  住院  /  呼吸治疗
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 P<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 (OR=2.687, 95%CI: 1.175~6.141, P=0.019), intrauterine growth retardation (OR=2.711, 95%CI: 1.106~6.646, P=0.029), premature rupture of membranes (OR=1.667, 95%CI: 1.139~2.438, P=0.008), chorioamnionitis (OR=4.852, 95%CI: 2.114~11.135, P<0.001), infectious diseases in the first week before delivery (OR=1.531, 95%CI: 1.015~2.310, P=0.042), turbidity of amniotic fluid (OR=3.170, 95%CI: 2.099~4.787, P<0.001), abnormal placenta (OR=2.335, 95%CI: 1.202~4.534, P=0.012), complications during pregnancy (OR=2.367, 95%CI: 1.360~4.118, P=0.002), and the use of glucocorticoids before delivery (OR=2.744, 95%CI: 1.219~5.528, P=0.009) were positively correlated with hospitalization within 24 h postnatally in late preterm and term neonates. Gestational age (OR=0.693, 95%CI: 0.602~0.797, P<0.001), 5-minute Apgar score (OR=0.026, 95%CI: 0.003~0.212, P=0.001), umbilical cord blood pH (OR=0.044, 95%CI: 0.002~0.793, P=0.034), and umbilical cord blood BE (OR=0.885, 95%CI: 0.823~0.823, P=0.001) were negatively correlated with it. Premature rupture of membranes (OR=0.207, 95%CI: 0.070~0.618, P=0.005), infectious diseases in the first week before delivery (OR=0.245, 95%CI: 0.070~0.854, P=0.027), 5-minute Apgar score (OR=0.063, 95%CI: 0.008~0.526, P=0.011), and abnormal C-reactive protein of newborns (OR=0.145, 95%CI: 0.046~0.460, P=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.

peripartum period  /  risk factors  /  neonates  /  hospitalization  /  respiratory therapy
唐书庆, 汪丽, 彭露, 刘慧. 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. 陆军军医大学学报, 2025 , 47 (5) : 472 -479 . DOI: 10.16016/j.2097-0927.202408040
Shuqing TANG, Li WANG, Lu PENG, Hui LIU. Risk factors for hospitalization within 24 h postnatally and respiratory support in late preterm and term neonates[J]. Journal of Army Medical University, 2025 , 47 (5) : 472 -479 . DOI: 10.16016/j.2097-0927.202408040
正文
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全球每年大约有1 500万早产儿出生，但近足月儿（晚期早产儿［1］，胎龄34~36+6周）占70%~80%［2-3］。34周以下早产儿由于各脏器发育不成熟，死亡率高于近足月及足月新生儿［1］（胎龄37~41+6周），由于近足月及足月新生儿发育相对成熟，其早期病情轻微变化可能容易被忽略，若不及时关注，病情可能恶化甚至危及生命［4-5］。围产期因素可引起近足月及足月新生儿出生后出现呼吸窘迫、低血糖、惊厥等情况［6-8］，从而导致其出生后24 h内住院甚至需要呼吸支持治疗等不良结局。因此，若在围产期及时筛查出影响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，找出可预防控制的环节，可减少其住院及呼吸支持治疗的发生。目前，围产期因素对近足月及足月新生儿的影响研究报道甚少，本研究通过围产期因素对影响近足月及足月新生儿出生后24 h内住院及呼吸支持治疗危险因素的分析，旨在早期识别围产期危险因素，并及时采取措施，降低此类新生儿出生后住院及呼吸支持治疗等不良结局的发生。
1　资料与方法
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1.1　研究对象
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出生的34周≤胎龄<42周新生儿作为研究对象。纳入标准：34周≤胎龄<42周的新生儿；排除标准：①患先天性膈疝、气管食管瘘、严重先天性心脏病等先天性畸形的新生儿；②患遗传代谢性疾病的新生儿；③资料不完整的新生儿。本研究通过重庆医科大学附属大学城医院伦理委员会审核批准（LL-202274）。呼吸支持治疗的标准：①当鼻导管、面罩或头罩吸氧时需吸入氧浓度>0.30时，动脉氧分压<50 mmHg或经皮血氧饱和度<90%；②呼吸暂停；③ 呼吸衰竭。
1.2　研究方法
采用病例对照研究，收集研究对象的临床资料，包括追溯其母亲孕期的一般资料［年龄、职业、教育程度、孕前体质量指数（body mass index，BMI）、分娩方式、是否吸烟/饮酒/吸毒、是否正规产检、是否胚胎移植、是否双胎/多胎、是否有剖宫产史、妊娠前基础疾病、胎儿宫内发育迟缓（intrauterine growth retardation，IUGR）、先兆早产、产前应用糖皮质激素］，妊娠晚期感染相关因素［胎膜早破（premature rupture of membranes，PROM）、绒毛膜羊膜炎（chorioamnionitis，CA）、产前1周患感染性疾病、产前血常规］，妊娠晚期缺氧相关危险因素（胎儿宫内窘迫、羊水浑浊、羊水量异常、脐带异常、胎盘异常），妊娠期并发症［妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）、妊娠期糖尿病（gestational diabetes mellitus，GDM）、妊娠期高血压（hypertensive disorders of pregnancy，HDP）、妊娠期贫血、妊娠期甲状腺功能异常和其他并发症］和新生儿的相关资料［胎龄、出生体质量、性别、Apgar 5分钟评分、脐血血气分析、新生儿第一次血常规和C反应蛋白（C-reactive protein，CRP）］。母亲孕前BMI按照中国妊娠期体质量增加建议标准［9］进行分类，低于相应标准为体质量增长不足，在标准范围内为增长适宜，高于相应标准为增长过度。根据出生后24 h内是否需要住院将近足月及足月新生儿分为住院组与非住院组；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。筛选影响34周≤胎龄<42周新生儿出生后24 h内住院及呼吸支持治疗的独立危险因素。
1.3　统计学分析
针对住院组与非住院组、呼吸支持治疗组与无呼吸支持治疗组新生儿的上述资料分别进行分析。采用SPSS 26.0统计学软件分析数据，符合正态分布的计量资料以x¯±s表示，组间比较采用t检验；计数资料以例（%）表示，组间比较采用χ2检验或Fisher精确概率法。将单因素分析中P<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。以P<0.05为差异有统计学意义。
2　结果
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2.1　一般资料
排除8例患先天性畸形及遗传代谢性疾病的新生儿后，共有1 468例样本量纳入分析。出生后24 h内入院新生儿的主要原因为呼吸增快、可疑感染、窒息、酸中毒，极个别为新生儿ABO溶血、低血糖、惊厥等因素。住院组213例，其中，男性新生儿116例，女性新生儿97例，胎龄（38.50±1.74）周，出生体质量（3 129.04±533.25）g；非住院组1 255例，其中，男性新生儿638例，女性新生儿617例，胎龄（39.15±1.13）周，出生体质量（3 289.44±398.26）g；2组间性别差异无统计学意义。亚组分析中，因感染性疾病住院新生儿的主要疾病为呼吸系统疾病及新生儿败血症，其纳入标准：①出生后24 h内出现呼吸增快、呻吟、发热/体温不升、少吃、少哭、少动等症状；②肺部影像学提示感染；③伴或不伴感染指标异常。呼吸支持治疗组48例，其中，男性新生儿32例，女性新生儿16例，胎龄（38.36±2.02）周，出生体质量（3 096.46±574.63）g；无呼吸支持治疗组102例，其中，男性新生儿56例，女性新生儿46例，胎龄（38.94±1.49）周，出生体质量（3 209.07±467.98）g；2组间性别、胎龄、出生体质量差异均无统计学意义。
2.2　近足月及足月新生儿出生后24 h内住院及需呼吸支持治疗风险的单因素分析
住院组与非住院组比较：住院组中，母亲未正规产检、胚胎移植、双胎/多胎、IUGR、先兆早产、PROM、CA、产前1周患感染性疾病、胎儿宫内窘迫、羊水浑浊、胎盘异常、HDP、妊娠合并其他疾病、产前应用糖皮质激素的比例及脐血乳酸（lactic acid，Lac）水平较非住院组高；母亲产前血小板（platelet，PLT）、胎龄、出生体质量、Apgar 5分钟评分、脐血酸碱度（pH）和脐血碱剩余（base excess，BE）的水平较非住院组低（P<0.05），见表1。
呼吸支持治疗组与无呼吸支持治疗组比较：呼吸支持治疗组中，剖宫产、羊水量异常的比例及脐血Lac水平较无呼吸支持治疗组更高；PROM、产前1周患感染性疾病、新生儿CRP异常的比例和Apgar 5分钟评分、脐血pH、脐血BE、新生儿白细胞（white blood cell，WBC）的水平较无呼吸支持治疗组更低（P<0.05），见表2。
2.3　近足月及足月新生儿出生后24 h内住院及需呼吸支持治疗风险的多因素Logistic 回归分析
将上述单因素分析中P<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，结果显示：母亲未正规产检、IUGR、PROM、CA、产前1周患感染性疾病、羊水浑浊、胎盘异常、妊娠期其他并发症、产前应用糖皮质激素为新生儿出生后24 h内住院的独立危险因素；胎龄、Apgar 5分钟评分、脐血pH、脐血BE为其独立保护因素，差异有统计学意义（P<0.05，表3）。PROM、产前1周患感染性疾病、Apgar 5分钟评分、新生儿CRP异常为出生后24 h内因感染性疾病住院新生儿需呼吸支持治疗的独立保护因素，差异具有统计学意义（P<0.05，表4）。
3　讨论
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3.1　孕期产检及母孕期合并症对其子代的影响
有研究显示，产前检查次数少是发生低出生体质量的危险因素［10］，合理的产前检查有利于预防产妇和新生儿死亡并改善分娩结果［11-12］。国内一项对8个省市的孕妇进行抽样调查的研究显示［13］，接受过孕早期检查的孕妇比例仅为61.87%，接受过至少5次检查的孕妇仅占78.79%，规范性胎心检查和合格性胎心检查分别为30.98%和8.03%。本研究中，2.45%（36/1 468）的产妇未进行正规产检，多因素Logistic回归分析显示，未正规产检是影响新生儿住院的独立危险因素（P<0.05）。因此，需加强孕妇产前保健宣传，特别是对妊娠期危险因素的筛查和评估，从而预防新生儿不良结局的发生。
本研究发现：妊娠期合并除ICP、GDM等常见并发症的其他少见并发症，如心律失常、肾功不全等是新生儿住院的独立危险因素。一项关于入住重症监护病房的危重孕产妇临床特征分析显示，38.16%的危重孕产妇因非产科因素入住重症监护病房，随着孕周增加，孕产妇的心脏负担持续加重，导致子宫胎盘血流异常，从而引起胎儿宫内缺氧，胎儿生后出现新生儿坏死性小肠结肠炎、呼吸窘迫综合征等不良结局［14］。妊娠合并大动脉炎会导致早产、新生儿窒息、新生儿入住新生儿重症监护室等不良结局［15］。
3.2　围产期感染相关因素与其子代的关系
本研究显示，PROM、CA和母亲产前1周患感染性疾病是新生儿出生后24 h内住院的独立危险因素。一项纳入4 742名产妇的研究显示［16］，新生儿复合结局、新生儿入住重症监护病房和产妇感染的发生率在PROM后随时间推移逐渐增加。组织学和临床CA均与新生儿早发和晚发败血症有关［17］，VENKATESH等［6］的研究表明，暴露于CA的胎龄≥34周新生儿发生不良结局的风险是未暴露者的3.5倍，出生后呼吸窘迫、机械通气、入院的风险也显著增加，与GOULD等［18］的研究结果相似。但宫内感染与新生儿呼吸系统疾病的关系说法不一。LEE等［19］的研究发现，宫内炎症可减少呼吸窘迫综合征发生的风险。BOHILTEA等［20］报道，与258例发生PROM 48 h内出生的近足月新生儿（胎龄35~36+6周）相比，16例PROM超过48 h的新生儿中，仅1例出现呼吸窘迫综合征，无1例进入新生儿重症监护室、接受气管插管及死亡。本研究也发现，PROM、母亲产前1周患感染性疾病和新生儿CRP异常是因感染性疾病住院新生儿需呼吸支持治疗的保护因素，这可能与产科医生对有PROM等宫内感染危险因素孕妇的高度重视、产前预防性使用抗生素及新生儿科医生对有疑似宫内感染/炎性指标升高新生儿关注更加密切，尽早使用抗生素有关，从而降低呼吸系统相关病情进展，降低需要呼吸支持治疗的风险。但本研究样本量较少，未将产前预防性使用抗生素纳入变量分析，故还需大样本多中心研究进一步证实。
3.3　围产期缺氧相关因素与其子代的关系
本研究结果显示，IUGR、羊水浑浊、胎盘异常是新生儿出生后24 h内住院的独立危险因素，提示可能与胎儿宫内缺氧和酸中毒导致多脏器损伤有关。引起IUGR因素众多，如胎盘异常可引起胎儿血供异常从而导致IUGR，IUGR通常提示存在慢性宫内缺氧的可能，是导致新生儿发病和死亡的重要原因，会显著增加新生儿呼吸系统相关疾病的发生［21］。
CHEN等［22］报道，Apgar 5分钟评分降低会导致足月新生儿不良结局、呼吸支持治疗及死亡率明显增加。本研究显示，Apgar 5分钟评分是新生儿出生后24 h内住院的保护因素，Apgar 5分钟评分越高，新生儿出生后24 h内住院的风险越低，患感染性疾病住院新生儿的呼吸支持治疗率越低。长期慢性宫内缺氧可减少肺表面活性物质分泌，影响胎肺成熟［23］，若胎儿在产前或产时吸入粪染的羊水，可导致物理性、化学性肺损伤，进一步加重肺损伤［24］，从而导致出生后因肺炎、胎粪吸入综合征甚至急性呼吸窘迫综合征而入院，严重者需要呼吸支持治疗。RAI等［25］的研究表明，与正常新生儿相比，Apgar 5分钟评分<7分的新生儿血清胆红素上升得更早，峰值更高。pH及BE是血气分析中判断酸碱度的重要指标，若胎儿宫内缺氧，可导致羊水粪染、胎儿或新生儿酸中毒、脐血pH及BE降低。RUIZ等［26］发现，脐血BE降低与新生儿低血糖及低血糖的严重程度呈正相关。SIMON等［27］的研究表明，代谢性酸中毒与新生儿死亡或脑瘫发生率有关。本研究也发现：与非住院组比较，脐血pH及脐血BE在住院组的水平更低，与上述报道相符。
3.4　胎龄对新生儿出生后结局的影响
本研究发现：胎龄是近足月及足月新生儿出生后24 h内住院的独立保护因素，胎龄越大，新生儿出生后24 h内住院的风险越低。早产儿因其生理特点，生后发生不良结局概率高于足月儿，胎龄越小，发生率也越高。既往研究认为，37周以后分娩相对安全，但是越来越多的研究表明［7-8］，早期足月儿［1］（胎龄37~38+6周）生后入住新生儿重症监护室、发生呼吸系统疾病、低血糖、高胆红素血症的概率仍高于晚期足月儿。同时，本研究发现，母亲产前应用糖皮质激素是新生儿出生后24 h内住院的危险因素，其原因考虑这类孕妇多有早产倾向，为促进胎肺成熟预防性使用糖皮质激素，而这类新生儿多为近足月儿或早期足月儿。
综上所述，围产期因素对近足月及足月新生儿出生后结局有重大影响。对未进行正规产检、存在IUGR、PROM、CA、产前1周患感染性疾病等危险因素的孕产妇及新生儿应高度重视，以降低新生儿发病率和不良结局风险。因感染性疾病住院的近足月及足月新生儿，即使无宫内感染危险因素，尽早干预也能减少呼吸支持治疗的需求。

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2025年第47卷第5期
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doi: 10.16016/j.2097-0927.202408040
  • 接收时间：2024-08-12
  • 首发时间：2026-10-30
  • 出版时间：2025-03-15
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  • 收稿日期：2024-08-12
  • 修回日期：2025-01-08
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    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

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2种不同金属材料的力学参数
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Number of
genus		 种数
Number of
species		 占总种数比例
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total species (%)		 属
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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