Analysis Of The Causes And Influencing Factors Of Hospital Condition Changes In 118 Premature Infants With Gestational Age ＜ 32 Weeks

Objective:By collecting the general clinical data of premature infants with gestational age<32 weeks in our hospital,the first symptoms and causes of recurrent changes in premature infants with gestational age<32 weeks were analyzed on the basis of stable condition after treatment,to explore the factors affecting the in-hospital changes of premature infants with gestational age<32 weeks,in order to provide more clinical basis for early identification of disease changes and early intervention of complications in premature infants with gestational age<32 weeks.Methods:A total of 118 premature infants with gestational age<32 weeks treated in NICU from January 2019 to December 2021 were selected as subjects.（1）According to the occurrence of in-hospital disease changes,the patients were divided into two groups:disease change group（n=93）and non-disease change group（n=25）.（2）According to the gestational age,the patients were divided into 26～26⁺⁶ group（n=1）,27～27⁺⁶ group（n=5）,28～28⁺⁶ group（n=21）,29～29⁺⁶ group（n=17）,30～30⁺⁶group（n=36）and 31～31⁺⁶ group（n=38）.Collect the basic data and clinical data of the subjects,Including the time of antibiotic use before and during hospitalization,oxygen therapy,ventilator-assisted ventilation time,invasive mechanical ventilation time,non-invasive mechanical ventilation time,peripheral central vein catheterization time,umbilical vein catheterization time,total parenteral vein nutrition time,total enteral nutrition establishment time,hospital feeling,blood culture,sputum culture,catheter tip culture,cerebrospinal fluid culture,midstream urine culture,the age and clinical symptoms,the cause of the change,the days of hospitalization,the cost of hospitalization,the outcome of discharge and the complications of preterm delivery.The research data were collated and statistically analyzed by SPSS 26.0 software.Results:（1）Fever is the most common clinical symptom in premature infants with gestational age<32 weeks,and other symptoms include respiratory symptoms（apnea,shortness of breath,dyspnea,cough,abnormal pulmonary auscultation）,digestive symptoms（abdominal distension,hematochezia,milk vomiting,poor milk intake,changes in intestinal sounds）,circulatory symptoms（unstable blood oxygen,increased/decreased heart rate,skin color changes）,as well as poor response,hypothermia and thrombocytopenia.（2）The main causes of disease changes are infectious diseases,among which hospital acquired pneumonia is the most common,and bronchopulmonary dysplasia is the most common among non-infectious diseases.（3）The time of oxygen therapy,ventilator-assisted ventilation,non-invasive mechanical ventilation,peripheral central venous catheterization,total parenteral nutrition,establishment of total enteral nutrition,days of hospitalization,cost of hospitalization,use of antibiotics and the risk of nosocomial infection in the change group were higher than those in the non-change group（P<0.05）,but there was no significant difference in the use of alveolar surfactant,invasive mechanical ventilation time and umbilical vein catheterization time（P>0.05）.（4）The risk of bronchopulmonary dysplasia and anemia in the disease change group was higher than that in the non-disease change group（P<0.05）,there was no significant difference in the risk of respiratory distress syndrome,feeding intolerance,necrotizing enterocolitis,intracranial infection,intracranial hemorrhage and septicemia（P>0.05）.（5）Oxygen therapy time,ventilator assisted ventilation time,invasive mechanical ventilation time,non-invasive mechanical ventilation time,total enteral feeding time and hospital stay were different in different gestational age groups（P<0.05）,there was no significant difference in umbilical vein catheterization time,peripheral central vein catheterization time and total parenteral vein nutrition time（P>0.05）.（6）The risk of feeding intolerance and septicemia was different in different gestational age groups（P<0.05）,there was no significant difference in the risk of respiratory distress syndrome,bronchopulmonary dysplasia,necrotizing enterocolitis,intracranial infection,intracranial hemorrhage and anemia（P>0.05）.（7）Antibiotic use（OR=1.20,95%CI=1.016～1.409）,non-invasive mechanical ventilation time（OR=1.44,95%CI=1.100～1.894）and total enteral feeding establishment time（OR=1.69,95%CI=1.172～2.440）were independent risk factors for the change of disease in premature infants with gestational age<32 weeks.Conclusion:（1）Fever is the most common early warning symptom of hospital changes in premature infants with gestational age<32 weeks,and hospital acquired pneumonia is the primary pathogeny of hospital changes in premature infants with gestational age<32 weeks.（2）The prolongation of oxygen therapy time,ventilator-assisted ventilation time,non-invasive mechanical ventilation time,peripheral central venous catheterization time,total parenteral nutrition time,total enteral nutrition establishment time and antibiotic use time increased the risk of in-hospital changes in premature infants with gestational age<32 weeks,making premature infants more likely to suffer from complications,longer hospital stay and higher hospitalization costs.（3）The results of multivariate logistic regression analysis showed that the use of antibiotics,the time of non-invasive mechanical ventilation and the time of establishment of total enteral feeding were the independent risk factors for the change of disease in premature infants with gestational age<32 weeks.