| ObjectivePremature rupture of membranes (PROM) is one of the most common complications of childbirth during perioperative, it can increase the incidence of intrauterine infection and puerperal infection, resulting in elevated rates of preterm birth.It can also lead to fetal distress, omphaloproptosis, which are important factors to cause fetal-neonatal prognosis and death. In recent years, with the development of society and economy, assisted reproductive technology, perinatal medical technology, the incidence of preterm infants is higher. With the incidence of premature birth in a rising trend, the distribution of preterm birth gestational age, birth weight, disease spectrum has changed gradually. Experience of diagnosis, treatment technology, previous nursing means can not satisfy these rapid changes. Although there is less relevant data in domestic for preterm infant treatment to the national, to advance with the times to understand the domestic status of preterm infants, we initiated the 2014 "The RDS occurrence rate of preterms and the influencing factors "in multicenter survey of a national multicenter epidemiological investigation. Through research on the multicenter epidemiological data in the current epidemiological characteristics of premature infants in China have certain understanding based on analysis of influence of PROM on obstetric preterm infants and for the clinical to take timely and effective measures of prevention and treatment provide the basis, to as far as possible to reduce the morbidity and mortality of premature infants and improve the survival rate of premature infants and improve the prognosis.Research data and methods1. Data and methods1.1 Research objects:the collaboration of obstetric birth gestational age less than 37 weeks premature, born by outside the hospital into a premature newborn ward in hospital cooperation are not included in this study. Exclusion criteria:stillbirth, stillbirth in the delivery room, because of serious congenital deformity in the delivery room give up treatment in children.1.2 Study sample source:This study set up an investigation group, collect the cross region of northeast and North China, Southern China, central China, northwest, southwest 6 area a total of 13 maternity hospitals born premature infants’data. Among them, the provincial capital city of the top three hospitals 8, the city’s top 3 hospitals, municipal two a hospital.1.3 Research sample size:the subject of registration information in 2014 01 01 0 to December 31,2014 24 of the gestational age<37 weeks of preterm infants. During the investigation,1 years obstetric hospitals from 13 live birth newborns were 75365 cases, including 7684 cases of premature infants, the incidence rate was 10.2%.2.Diagnostic criteria2.1 The diagnosis of PROM:premature rupture of membranes in labor before fracture said for the prom, the diagnosis of PROM requires a combination of clinical and laboratory findings:(1). Women complained of sudden appearance of vaginal fluid or without control "leak", a little pregnant women only feeling wet, vaginal examination visible with fat tires of amniotic fluid flowing out from the opening of the cervix; (2). Vaginal fluid pH check pHI>6.5; 3. Vaginal fluid drying film examination sees fern plant leaf crystallization; (4) necessary to bind to insulin-like growth factor binding protein-1 and placental alpha microglobulin-1 testing and ultrasonic inspection auxiliary diagnosis fault.2.2 Respiratory distress syndrome (RDS) in preterm neonates, broncho- pulmonary dysplasia(BPD), intracranial hemorrhage(ICH), necrotizing enterocolitis (NEC), retinopathy in preterm neonates(ROP), patent ductus arteriosus(PDA), sepsis, pulmonary hemorrhage are defined according to relevant literature.2.3 Antenatal fever, premature rupture of fetal membranes, placental abruption, placenta previa, pregnant hypertension, gestational diabetes mellitus are defined according to relevant literature.Abnormality of amniotic fluid includes polyhydramnios(>2000ml), oligohydramnios(<300ml), amniotic fluid turbidity, meconium-staining amniotic fluid, et al. Abnormality of umbilical cord includes twining, twist, tieing, prolapse, edema, et al. All neonates were studies for assess-ment of maternal characteristics, neonatal demographic features, interventions performed after birth, and survival.3.METHODS3.1 Research index① Gender, gestational age, birth weight and other general conditions, the incidence of RDS, etc..② Perinatal factors:premature rupture of parity, birth times, whether multiple pregnancy, mode of delivery, maternal age, pregnancy, prenatal dexamethasone application, antepartum fever and membranes, chorion amnion phlogistic, placental abruption, placenta previa, pregnancy induced hypertension, pregnancy with gestational diabetes mellitus (GDM), abnormal amniotic fluid, umbilical cord abnormality, mother in peripheral blood white blood cell count (WBC), mother of C-reactive protein (CRP), father’s age, neonatal asphyxia.③ Treatment:resuscitation, prenatal hormone use, mechanical ventilation, the use of antibiotics, feeding, intravenous nutrition, drugs and surgical treatment, etc.④ The auxiliary examination results:blood routine, biochemical, ultrasound, X-ray etc.⑤. The incidence of major complications:including ICH, ROP, BPD, NEC, PDA, pulmonary hemorrhage and sepsis, etc..⑥. The death rate:the standard of death is the standard of death, including the death of the hospital during the period of hospitalization, the failure of the treatment after the death, the failure of the birth and death.1.3.2 Grouping:according to whether the occurrence of PROM is divided into PROM group and control group,2889 cases in PROM group and 4795 cases in control group.1.4 Statistical analysis:using SPSS 20.0 software to carry on the analysis, the measurement data with mean±standard deviation (X±s), comparation between the two groups was used two independent samples t test; count data expressed by rate and the chi square test and does not comply with the chi square test conditions using Fisher’s exact probability method; multi factor analysis of mining using logistic regression analysis, P<0.05 for difference was statistically significant.RESULTS2.1 The incidence of preterm infant and RDS in each cooperative hospitalThere was a total number of 75365 live newborn infants in all 13 hospital,7684 cases were preterms among them and the preterm rate was 10.2%. The number of preterm infants with PROM was 2889 and the incidence was 15.4%; 1185 cases of preterm infants were RDS, the average incidence rate of RDS was 15.4%.2.2 The gestational age composition ratio and the incidence of PROM、RDS in premature infantsIn this study, mean gestational age was 34.4±2.2; the number of infants with gestational 34-36 weeks is 5308, counting for 69%; the number of very preterm infants is 966, counting for 12.6%; the number of extremely preterm infants is 101, counting for 1.3%. PROM children with mean gestational age was 34.4±2.1 weeks, infants with RDS mean gestational age was 31.7±2.6 weeks (23.3～36.9). There was no obvious rule in the incidence of PROM in different gestational age group, the incidence rate of RDS in premature infants decreased with the increase of gestational age.2.3 Comparison of incidence rate of PROM and RDS in preterm infants with different birth weightThe average birth weight in preterm infants was 2242.9+571.1g (200-5225g); 738 cases below 1500g, accounting for 9.6% The average birth weight of PROM was 2268.5+551.3g, and the average birth weight of RDS was 1697.2+551.8g. There was no obvious rule in the incidence of PROM in different groups of different birth weight groups. The incidence of RDS in preterm infants decreased gradually with the increase of birth weight.2.4 Effect of PROM on the incidence of RDS in preterm infants with different gestational ageThe results showed that the gestational age subdivision, when gestational age less than or equal to 28 weeks in PROM group and the RDS incidence rate in the control group has no obvious rules, and the incidence between the 2 groups of RDS was not statistically significant; when gestational age> 28 weeks, the RDS occurrence rate decrease with the increase of gestational age in both groups, the difference was not statistically significant (P> 0.05).2.5 Effect of PROM on the incidence of RDS in different birth weight groupsStatistical Prom on different weight groups premature RDS occurred rate. The results showed that birth weight is divided into seven categories found the incidence of RDS decreased with the increase in birth weight, when the birth weight range of 750 to 2500g Prom group premature RDS incidence rate was higher than that of control group, birth weight large 2500g in prom group premature RDS occurred was lower than that of the control group, which 1000g is less than or equal to BW<2500g, BW>4000g weight groups of RDS occurrence rate between the 2 groups were compared with statistical significance (P<0.05).2.6 Effect of PROM on the treatment and prognosis of premature infantsResults:non invasive ventilation ratio (%), PS using the number is more than or equal to 2 times ratio (%) and invasive ventilation time (day), assisted respiration (days), the total oxygen time (days), length of hospital stay (days), the cost of hospitalization (million yuan) Prom group were higher than those of the control group, the difference between the two groups had no statistical significance (P> 0.05); a ventilation ratio (%) and noninvasive ventilation time (days) Prom group were lower than those of the control group, the difference between the 2 groups without statistically significant (P> 0.05).2.7 Effect of PROM on mortality and major complications of preterm infantsBetween the two groups in mortality and complications compared. It is found that the prom group had lower mortality rate than the control group, the difference was statistically significant (P< 0.05) and ors,95% CI< 1, prompt premature rupture of membranes may for mortality of protective factors; Prom ICH group, NEC, ROP and BPD incidence were higher than those in the control group, the difference is statistically significant (P< 0.05) and ors,95% CI> 1, prompt premature rupture of membranes, premature rupture risk factors for ICH, NEC, ROP and BPD complications, RDS, PDA, sepsis occurred rate between the two groups showed no significant difference.After adjusting for gestational age, birth weight, sex, mode of delivery, placental abruption, placenta previa, prenatal hormones, pregnancy with gestational diabetes mellitus (GDM), gestational period hypertension disease and 5 minutes to score grading of weredivided factors analysis, NEC, ROP and BPD incidence rate difference between the two groups was statistically significant (P< 0.05), but the mortality rate and ICH compared statistically significant (P> 0.05). The or value of 95% CI> 1. Premature rupture of membranes (PROM) were risk factors of complications of NEC, ROP and BPD.2.8 Effect of PROM on the parentProm maternal white blood cell count and C-reactive protein count, blood culture positive rate, vaginal secretions positive culture, other culture such as sputum, urine culture, culture and culture of cerebrospinal fluid and positive rate was higher than that of the control group, of which the blood culture positive rate and other culture positive rate between the 2 groups difference has statistical significance (P< 0.01).2.9 Comparison mortality rate between PROM group and the control groupThe mortality rate,in PROM group was 1.6%, the mortality rate in control group was 2.6%, the difference between the two groups is statistically significant (x2 2=7.9142P=0.0049). Subdivision gestational age, prom group mortality was lower than that of the control group. The gestational age is less than or equal to 25 weeks, the gestational age of 30 weeks between the 2 groups mortality was statistically significant (P< 0.05).2.10 Effect of duration of premature complications of 10 premature rupture of membranesThe premature rupture of membranes (PROM) duration is divided into 3 time <24h,24h time is less than or equal to <48h, time is more than or equal to 48h group, compared complications between the groups occurred. The results show that except for BPD, PDA, sepsis occurred rate with premature rupture of membranes (PROM) for an extended period of time, gradually increase the occurrence rate and other complications occurred rate and fetal membrane early broken time had no obvious regularity. Among them, PDA sepsis rate was statistically significant between the 3 groups (p<0.05).Conclusion1. PROM had no obvious effect on the incidence of RDS in different gestational age groups.2. Multivariate regression analysis showed that PROM was a risk factor for the occurrence of BPD, ROP and NEC.3. Although PROM can lead to NEC, ROP, BPD and other high incidence of complications, but through active prevention of prenatal treatment, did not cause a high mortality rate. |
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