患病新生儿急性损伤 (aki) 的预测因素和风险评分系统 - 一项前性队列研究
Kagnur Ramya1, Kanya Mukhopadhyay2, Jogender Kumar2
1Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education And Research (PGIMER), Chandigarh, India. ramya2821992@gmail.com.
European journal of pediatrics
|October 15, 2024
概括
新生儿急性损伤 (AKI) 影响了近一半的生病新生儿,尤其是极度早产的婴儿. 败血症,通风,酸化和围产期窒息是AKI的关键危险因素.
科学领域:
- 新生儿科学 新生儿科学
- 儿科脏病学 儿科脏病学
- 关键护理医学 关键护理医学
背景情况:
- 新生儿急性损伤 (AKI) 是患病新生儿的重大并发症,与增加的发病率和死亡率有关.
- 导致新生儿AKI的因素包括窒息,早产,败血症,休克,低血压,某些药物和先天性心脏病.
- 现有知识强调了新生儿AKI的多因素性质.
研究的目的:
- 为了确定AKI的发病率,风险因素和结局,病患的新生儿入院到III级新生儿重症监护室 (NICU).
- 开发和验证一种风险预测模型,用于识别患有AKI高风险的新生儿.
主要方法:
- 一项前性队列研究,涉及276名生病的新生儿 (不包括患有先天性异常或早期死亡的新生儿).
- 根据KDIGO指导方针来定义和分类AKI.
- 使用考克斯回归分析来识别显著的风险因素,并开发并评估诊断准确性的风险预测模型.
主要成果:
- AKI的总发病率为42% (115/276名新生儿),在极度早产婴儿 (<28周) 中观察到的最高发病率 (71%).
- 严重的AKI风险因素包括败血症 (HR 4),侵入性通风 (HR 2.3),酸性疾病 (HR 1.9) 和围产期窒息 (HR 1.5).
- 风险预测模型表现出良好的诊断准确度 (AUC 83.6%),敏感度为77%,特异性为80%. 患有AKI的新生儿的死亡率明显较高 (39%对3%,p<0.01).
结论:
- AKI在生病的新生儿中非常普遍,特别是在极度早产的婴儿中.
- 败血症,侵入性通风,酸化和围产期窒息是识别患有AKI风险的新生儿的关键预测因素.
- 结合这些因素的简单风险预测模型可以有效地识别有风险的婴儿,有助于及时干预和改善结果.
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