[Predictive effect of neonatal morbidities on the poor outcomes at 12 months corrected age in very low birth weight premature infants].

Objective: To investigate the prognostic effect of neonatal morbidities on poor outcomes at 12 months corrected age in very low birth weight (VLBW) premature infants . Method: From November 2013 to October 2014, a multi-center retrospective study was conducted in 8 tertiary Maternal and Children's hospitals in Guangdong, Hunan and Fujian. The premature infants survived to a postmenstrual age (PMA) of 36 weeks with birth weight less than 1 500 g and without congenital diseases were included, and divided into two groups according to poor outcomes. The birth weight, gestational age, morbidities and poor outcomes (death, cerebral palsy, cognitive delay, et al) were recorded. Data were analyzed with Chi-square test to investigate the relationship between morbidities and poor outcomes. And the predictive effect of the top three morbidities were analyzed by Logistic regression analysis. Result: Total of 834 VLBW premature infants (473 boys and 361 girls) finished the follow-up, whose average gestational age and birth weight were (30.6±1.8) weeks and (1 189±159)g. The incidences of BPD, severe ROP, NEC, brain injury and sepsis were 207 (24.8%), 119 (14.3%), 58 (7.0%), 281 (33.7%) and 124 (14.9%), respectively. There were significant differences between the two groups in the incidences of BPD, severe ROP, NEC, brain injury and sepsis(χ(2)=42.10, 47.20, 4.81, 44.28, 18.63, all P<0.01), which had significant correlation with poor outcomes at 12 months corrected age. The three top morbidities were severe ROP, BPD and brain injury(OR=3.82, 2.90, 2.80). Combined morbidities with BPD, severe ROP and brain injury correlated with higher risk of poor outcomes (one morbidity, OR=3.14, β=1.15; two morbidities, OR=7.31, β=1.99; three morbidities, OR=22.41, β=3.11; all P<0.01). Conclusion: BPD, severe ROP, NEC, brain injury and sepsis were the risk factors of poor outcomes at 12 months corrected age in VLBW infants. And the more combined morbidities with severe ROP, BPD and brain injury, the higher risk of poor outcomes in this population. Trial registration Clinical Trails, NCT03104946.目的： 探讨极低出生体重早产儿新生儿期并发症对其校正胎龄12月龄不良预后的预测性。 方法： 采用多中心、回顾性研究，以2013年11月至2014年10月广东、湖南、福建8家三级甲等妇幼保健院新生儿科收治的出生体重低于1 500 g的早产儿为研究对象，回顾性收集其基本资料(出生体重、胎龄、并发症情况等)及校正胎龄12月龄时的随访结果。剔除校正胎龄36周前死亡及未完成随访者。根据有无不良预后进行分组，比较并发症的发病率，根据比值比(OR)值筛选风险前3高的并发症；以合并并发症的数量再次分组，采用Logistic回归进行危险因素分析。 结果： 共入组834例，男473例、女361例，平均出生胎龄(30.6±1.8)周，平均出生体重(1 189±159)g。支气管肺发育不良(BPD)、严重早产儿视网膜病变(ROP)、新生儿坏死性小肠结肠炎(NEC)、脑损伤、败血症分别为207例(24.8%)、119例(14.3%)、58例(7.0%)、281例(33.7%)、124例(14.9%)，以上并发症发病率在有无不良预后两组(分别为253、581例)差异均有统计学意义(χ(2)＝42.10、47.20、4.81、44.28、18.63，P均<0.01)，其中风险系数前3高的并发症依次为：严重ROP、BPD、脑损伤(OR＝3.82、2.90、2.80)。合并严重ROP、BPD、脑损伤会进一步增加极低出生体重儿在校正胎龄12月龄不良预后的风险，且与合并症的数量正相关(1种并发症OR＝3.14，β＝1.15；合并2种并发症OR＝7.31, β＝1.99；合并3种并发症OR＝22.41，β＝3.11；P均<0.01)。 结论： BPD、严重ROP、NEC、脑损伤、败血症是极低出生体重儿校正胎龄12月龄不良预后的高危因素；合并BPD、严重ROP、脑损伤会进一步增加患儿校正胎龄12月龄不良预后的风险，合并数量越多，预测价值越大。临床试验注册美国临床试验数据库，NCT03104946。.