欢迎访问《中国循证儿科杂志》官方网站，今天是
English Version
中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (2): 104-108.

• 论著 • 上一篇    下一篇

妊娠期肝内胆汁淤积症孕妇分娩的新生儿入住NICU的影响因素分析

罗丽1,3,冉丽红2,3,代妮娅1,包蕾2,陈龙2   

  1. 1重庆市永川区妇幼保健院妇产科重庆，402160；2重庆医科大学附属儿童医院新生儿诊治中心，儿科学重庆市重点实验室，儿童发育疾病研究教育部重点实验室，国家儿童健康与疾病临床医学研究中心，儿童发育重大疾病国家国际科技合作基地重庆，400014；3共同第一作者
  • 收稿日期:2021-12-23 修回日期:2022-02-13 出版日期:2022-04-25 发布日期:2022-04-25
  • 通讯作者: 陈龙

Correlation between intrahepatic cholestasis of pregnancy and neonatal admission to NICU

LUO Li1,3, RAN Lihong2,3, DAI Niya1, BAO Lei2, CHEN Long2   

  1. 1 Maternal and Child Health Hospital of Yongchuan District, Chongqing 402160, China; 2 Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University; Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China; 3 Co-first author
  • Received:2021-12-23 Revised:2022-02-13 Online:2022-04-25 Published:2022-04-25
  • Contact: CHEN Long, email: neurochenglong@126.com

PDF

313

摘要： 背景：妊娠期肝内胆汁淤积症（ICP）可能导致新生儿不良结局。 目的：探讨ICP孕妇分娩的新生儿生后24 h内入住新生儿重症监护室（NICU）的危险因素。设计：单中心病例对照研究。 方法：纳入2015年1月至2019年12月在重庆市永川区妇幼保健院娩出、母亲明确诊断ICP且本次为单胎妊娠的新生儿，根据其生后24 h内是否入住NICU分为住院组和非住院组，样本量计算显示每组至少需要131例新生儿。截取母亲孕期及分娩时资料、新生儿资料以及生后24 h内入住NICU情况和原因。采用二元Logistic回归分析影响ICP孕妇分娩的新生儿入住NICU的独立危险因素，构建ROC曲线评估这些危险因素对新生儿入住NICU的预测价值。 主要结局指标：ICP孕妇分娩的新生儿NICU住院的影响因素及预测因素。 结果：ICP孕妇娩出的新生儿621例，平均胎龄38.3(37.0，39.3)周，平均出生体重3 148±461)g，男308例。生后24 h内入住NICU（住院组）133例（21.4%），主要原因包括早产（78例）、呼吸窘迫（20例），低血糖、反应差和感染等；非住院组488例。住院组胎龄、出生体重、5 min Apgar评分、母亲诊断ICP的孕周均小于或低于非住院组，母亲分娩前最后1次ALT、AST、胆汁酸水平和新生儿早产率均高于非住院组，差异均有统计学意义。新生儿均随访至生后28 d，死亡1例（0.16%）。二元Logistic回归分析显示，胎龄小（OR=0.378，95%CI：0.301~0.474，P<0.001），母亲孕期皮肤瘙痒（OR=2.410，95%CI：1.411~4.114，P=0.001）、胆汁酸水平高（OR=1.016，95%CI：1.003~1.028)，P=0.012）和母亲产前BMI低（OR=0.930，95%CI：0.873~0.990，P=0.023）是新生儿生后需要NICU住院治疗的危险因素.ICP孕妇分娩的新生儿生后24 h内入住NICU的预测因素及性能：ICP母亲伴孕期皮肤瘙痒症状时，新生儿胎龄（最佳诊断界值≤36.6周）、母亲胆汁酸水平（最佳诊断界值＞20 μmol·L-1）和产前BMI（ 最佳诊断界值≤24 kg·m-2）联合诊断的敏感度达96.7%(95%CI：90.8%~99.3%）；ICP母亲不伴孕期皮肤瘙痒症状时，新生儿胎龄（最佳诊断界值≤36.5周）、母亲胆汁酸（最佳诊断界值＞26.8 μmol·L-1）和产前BMI（最佳诊断界值＞24 kg·m-2）联合诊断的敏感度达78.0%（95%CI：62.4%~82.4%）。 结论：胎龄小、母亲孕期皮肤瘙痒、孕期胆汁酸水平高和孕前BMI低是ICP母亲分娩的新生儿生后需要NICU住院治疗的危险因素。ICP孕妇伴孕期皮肤瘙痒症状时，胎龄≤36.6周、母亲孕期胆汁酸水平＞20 μmol·L-1和产前BMI≤24 kg·m-2联合预测新生儿NICU住院治疗的敏感度达96.7%。

关键词: 妊娠期肝内胆汁淤积症, 新生儿重症监护室, 危险因素, 敏感度, 特异度

Abstract: Background：Intrahepatic cholestasis of pregnancy (ICP) may lead to adverse neonatal outcomes. Objective：To investigate the risk factors of Neonatal Intensive Care Unit (NICU) admission of newborns delivered by mothers with ICP within 24 hours after birth. Design：Singlecenter casecontrol study. Methods：From January 2015 to December 2019, the newborns whose mothers gave birth to a single baby at Maternal and Child Health Hospital of Chongiqng Yongchuan District and were diagnosed with ICP were selected as the study subjects. According to whether they were admitted to NICU within 24 hours of life, they were divided into NICU admission group and nonNICU admission group. Sample size was estimated that 131 newborns would be needed at least in each group. The clinical data of mothers and newborns were retrospectively analyzed, and the risk factors of NICU admission within 24 hours of life were analyzed by binary logistic regression model. Receiver operating characteristic (ROC) curve was used to predict the the independent risk for the NICU admission factors. Main outcome measures：The risk factors and predictive factors of NICU admission of newborns delivered by mothers with ICP within 24 hours of life. Results：A total of 621 newborns (308 males) delivered by mothers with ICP were included. The average gestational age was 38.3 (37.0, 39.3) weeks, and the average birth weight was 3 148±461 g. There were 133 (21.4%) newborns admitted to NICU within 24 hours of life because of preterm(n=78), respiratory distress(n=20), hypoglycemia, poor response, infection and 488 newborns were not admitted to NICU. Compared with the nonNICU admission group, the gestational age, birth weight, 5 min Apgar score and gestational age at diagnosis of the NICU admission group were lower, and the ALT, AST, bile acid of last test, and preterm of the NICU admission group were higher, and the differences were statistically significant. One (0.16%) newborn died at followup within 28 days of life. Logistic regression analysis showed that small gestational age (OR=0.378, 95%CI: 0.3010.474, P<0.001), itch (OR=2.410, 95%CI: 1.4114.114, P=0.001), high bile acid (OR=1.016, 95%CI: 1.0031.028, P=0.012) and low BMI before pregnancy (OR=0.930, 95%CI: 0.8730.990, P=0.023) were the risk factors of NICU admission. The predictive factors of NICU admission of newborns delivered by mothers with ICP within 24 hours of life were as the follow: a. When those mothers were combined with itch, the sensitivity was 96.7% (95%CI: 90.8%99.3%) for the combination of gestational age (the optimal cutoff: ≤36.6 weeks), maternal bile acid (the optimal cutoff: >20 umol·L-1) and BMI before pregnancy (the optimal cutoff: ≤24 kg·m-2); b. When those mothers were not with itch, the sensitivity was 78.0% (95%CI: 62.4%82.4%) for the combination of gestational age (the optimal cutoff: ≤36.5 weeks), maternal bile acid (the optimal cutoff: >26.8 umol·L-1) and BMI before pregnancy (the optimal cutoff: ＞24 kg·m-2). Conclusion：Small gestational age, itch, high bile acid level and low BMI before pregnancy of the mother were independent risk factors for NICU admission of newborns delivered by mothers with ICP. When those mothers were with itch, the sensitivity was 96.7% for the prediction of NICU admission through the combination of gestational age ≤36.6 weeks, maternal bile acid >20 umol·L-1 and BMI before pregnancy ≤24 kg·m-2.

Key words: Intrahepatic cholestasis of pregnancy, Neonatal intensive care unit, Risk factors, Sensitivity, Specificity