The Incidenceand Clinical Risk Factors Analysis Of Preterm With HMD

Objective1.For reasonable clinical diagnosis and treatment of premature with deseases and providing evidence,investigating the latest epidemiological data of premature in Liaocheng People's Hospital.2.To provide guidance for the preventive medicine to take corresponding effective measures to reduce the incidence of premature HMD,we explore high-risk factors of infant with HMD by comparing the premature HMD data in the perinatal period with those of the non-HMD premature babies.3.To provide warning indicators for early evaluation of clinical disease and predict prognosis better,we explore the characteristics and risk factors of premature HMD among different gestational age stages by comparing the premature HMD data among different gestational age groups with those of the non-HMD.Methods1.All clinical data of preterms birth in our hospital from 1.1 2013 to 12.312014 were collected and organized.Preterms via induced abortion were eliminated due to various reasons such as an unplanned pregnancy.A total of 1325 neonatal latest epidemic ological surveys were analyzed.2.There were 1325 preterm infants born in our hospital.189 cases of them who didn't accept the treatment for a variety of reasons or have incomplete clinical data were eliminated,including gestational age 25³1⁺⁶w,32³3⁺⁶w,34³6⁺⁶w for31,11,147 cases,respectively and 5 oafs with deformity seriously affect the respiratory system diagnosis and prognosis).Eventually,1136 complete clinical cases were adopted.Detailed clinical data records of premature babies and his mother were recorded.They were divided into two groups according to diagnostic criteria of“Neonatal Respiratory Distress Syndr ome”which are in the fourth edition of"The Practical Neonatology,Chapter 9 Section 7,Xiao-mei Shao as editor in chief,published by“people's medical publishing house”in 2011.There were 239 HMD cases as Case Group,and 897 non-HMD cases as Control Group.Case-control analysis and binary logistic regression were applied to explore clinical risk factors of premature HMD.3.1136 cases were divided into three groups 26³1⁺⁶w,32³3⁺⁶w,34³6⁺⁶w for 177,273,686 cases.Case-control analysis and binary logistic regression were applied to explore the differences of clinical risk factors of preterm HMD among different gestate onal-age groups.Results1.Characteristics of preterm born in our hospitalFrom 1.1 2013 to 12.31 2014 in our hospital,the morbidity of premature birth was 14.94%.The morbidity of premature HMD was 2.86%,accounted for 19.17%of live premature birth.SGA accounted for 19.75%of live premature birth.Preterms born in the second and third quarters were less than the first and forth quarters,but premature HMD was much more.Premature HMD morbidity decreased with increasing gestational age and birth weight.There was no significant difference in the morbidity of birth defects among three gestational-age groups,and oaf accounted higher in late preterm group.The admission rate in our hospital is 85.74%,and the rate of 26³1⁺⁶w and34³6⁺⁶w groups were lower slightly.The ratio of the mild and the severe of premature HMD in our hospital was 2:1,the severe accounted for almost a third.Premature mortality and case fatality rate of premature HMD decreased graduately with increasing gestational age,the proportion of 25³1⁺⁶w is the largest2.Analysis of Risk Factors of Premature HMD1136 complete clinical cases were divided into 239 cases of premature HMD?Case Group?and 897 cases of non-HMD?Control Group?.Single factor analysis showed that influence factors of premature HMD were preterms born in the second and third quarters,male,asphyxia,smaller gestational age,lower birth weight,placental abruption,placenta previa,the WBC count of mother in the perinatal period more than 12×10⁹/L,mother pregnant 3 times or more,cesarean delivery,premature rupture of membranes,father had a high school degree of culture and so on.Gestational diabetes mellitus can be considered as suspected influencing factors of premature HMD.Logistic regression analysis showed the independent risk factors of premature HMD?by the OR value order?:GA26³1⁺⁶w,BW<1500 g,gestational diabetes mellitus,GA32³3⁺66 weeks,male,placenta previa,the WBC count of mother in the perinatal period more than 12×10⁹/L,mother pregnant 3 times or more and so on.3.1 26³1⁺⁶w 177 cases,32³3⁺⁶w 273 cases,34³6⁺⁶w 686 cases,accounted preterms for 15.58%,24.03%and 60.39%respectively.With the increase of GA,BW,proportion of male,cesarean section rate,the proportion of SGA and admission time from birth increased gradually,and hospital stays increased gradually.GA,BW,cesarean section rate and hospital stays had statistically significant differences among three groups,but proportion of male,age of parents,production times,proportion of SGA and admission time from birth didn't have.3.2.1 Single factor analysis showed that influence factors of premature HMD in26³1⁺⁶w were preterms born in the second and third quarters,male,asphyxia,mother had a high school degree of culture,placenta previa,the WBC count of mother in the perinatal period more than 12×10⁹/L,BW<1500 g,GA26²9⁺66 weeks and so on.PIH can be considered as suspected influencing factors of premature HMD.Logistic regression analysis showed the independent risk factors of premature HMD?by the OR value order?:BW<1500 g,male,asphyxia.3.2.2 Single factor analysis showed that influence factors of premature HMD in32³3⁺⁶w were preterms born in the second and third quarters,mother pregnant 3times or more,asphyxia,cesarean delivery,GA32³2⁺⁶w,placenta previa,prenatal dexamethasone and course.The WBC count of mother in the perinatal period more than 12×10⁹/L,gestational diabetes mellitus,male,can be consider as suspected influencing factors of premature HMD according to clinical situation.Logistic regression analysis showed the independent risk factors of premature HMD?by the OR value order?:born in the second and third quarters,gestational diabetes mellitus,GA32³2⁺⁶w,cesarean delivery,mother pregnant 3 times or more,asphyxia.3.2.3 Single factor analysis showed that influence factors of premature HMD in34³6⁺⁶w were preterms born in the second and third quarters,male,asphyxia,placenta previa,gestational diabetes mellitus,GA34³4⁺⁶w.Age of mother>35 years can be consider as suspected influencing factors of premature HMD according to clinical situation.Logistic regression analysis showed the independent risk factors of premature HMD?by the OR value order?include asphyxia,gestational diabetes mellitus,male,preterms born in the second and third quarters.Conclusion1.The morbidity of preterm and premature HMD,admission rate,proportion of SGA are higher than the national average,and the slightly higher premature mortality,premature HMD fatality rate,to some extent,reflect the characteristics of hospitalized premature infants in the regional first-class comprehensive hospital and its healing ability.2.The main risk factors of premature HMD include small GA,low BW,male,neonatal asphyxia,gestational diabetes mellitus,cesarean section,born in the second and third quarters,placenta previa,mother pregnant 3 times or more and so on.Suspicious risk factors include maternal gestational hypertension disease,the WBC count of mother in the perinatal period more than 12×10⁹/L,prenatal dexamethasone and course and age of mother>35 years and so on.3.Influence factors of premature HMD among three groups are not identical.GA can be considerd in the process of clinical diagnosis and treatment.4.Characteristics of hospitalized premature infants and their maternal perinatal conditions in our hospital is not identical with the rest of China.To explore better prevention and control measures for premature HMD,characteristics of hospitalized premature infants,maternal perinatal conditions,economic bear ability,cultural tradition etc.should be considered in clinical diagnosis and treatment.5.To reduce the morbidity of preterm birth,we would strengthen to mission pregnancy care,regular antenatal examination,control blood sugar well in gestational diabetes mellitus and reduce potential safety problems of maternal perinatal health.To reduce the morbidity and severity of asphyxia,we would strengthen the neonatal asphyxia recovery training.Be vigilant with preterms had risk factors,and then improve the level of prevention and treatment knowledge for premature HMD.