Cause of preterm birth and late-onset sepsis in very preterm infants: the EPIPAGE-2 cohort study.
Cause of preterm birth and late-onset sepsis in very preterm infants: the EPIPAGE-2 cohort study.
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极早产儿中早产和迟发性脓毒症的原因：EPIPAGE-2队列研究
DOI：
10.1038/s41390-021-01411-y
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发表时间：
2021-09
影响因子：
3.6
通讯作者：
EPIPAGE-2 Working Group on Infections
中科院分区：
文献类型：
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作者：
Letouzey M;Foix-L'Hélias L;Torchin H;Mitha A;Morgan AS;Zeitlin J;Kayem G;Maisonneuve E;Delorme P;Khoshnood B;Kaminski M;Ancel PY;Boileau P;Lorthe E;EPIPAGE-2 Working Group on Infections
早产儿迟发性脓毒症(LOS)的发病机制尚不清楚，对危险因素，特别是产前危险因素的了解也有限。本研究旨在评估早产原因与极早产儿LOS之间的关系。来自一项基于全国人群的队列研究的2052名生活在72 h的早产儿被纳入其中。采用生存分析和COX回归模型，根据早产原因比较无LOS的存活率。437例(20.1%)至少有一次LOS发作。不同原因早产的发生率不同：早产17.1%，胎膜早破17.9%，胎盘早剥20.3%，单纯高血压20.3%，高血压伴胎儿生长受限27.5%，单纯胎盘早破29.4%。多因素分析显示，与早产后出生的婴儿相比，高血压病(HR = 1.7，95%CI = 1.2~2.5)、高血压病合并FGR(HR = 2.6，95%CI = 1.9~3.6)和单纯性FGR(HR = 2.9，95%CI = 1.9~4.4)后出生的婴儿的风险仍较高。与早产后出生的婴儿相比，高血压疾病后出生的早产儿或FGR后出生的早产儿发生LOS的风险更高。晚发性败血症的风险因早产原因而异。与早产后出生的婴儿相比，因妊娠高血压疾病和/或胎儿生长受限而早产的婴儿患迟发性脓毒症的风险增加。应考虑产前因素，特别是导致早产的各种原因，以便更好地预防和管理新生儿感染发病率，并告知父母。
The pathogenesis of late-onset sepsis (LOS) in preterm infants is poorly understood and knowledge about risk factors, especially prenatal risk factors, is limited. This study aimed to assess the association between the cause of preterm birth and LOS in very preterm infants. 2052 very preterm singletons from a national population-based cohort study alive at 72 h of life were included. Survival without LOS was compared by cause of preterm birth using survival analysis and Cox regression models. 437 (20.1%) had at least one episode of LOS. The frequency of LOS varied by cause of preterm birth: 17.1% for infants born after preterm labor, 17.9% after preterm premature rupture of membranes, 20.3% after a placental abruption, 20.3% after isolated hypertensive disorders, 27.5% after hypertensive disorders with fetal growth restriction (FGR), and 29.4% after isolated FGR. In multivariate analysis, when compared to infants born after preterm labor, the risk remained higher for infants born after hypertensive disorders (hazard ratio HR = 1.7, 95% CI = 1.2–2.5), hypertensive disorders with FGR (HR = 2.6, 95% CI = 1.9–3.6) and isolated FGR (HR = 2.9, 95% CI = 1.9–4.4). Very preterm infants born after hypertensive disorders or born after FGR had an increased risk of LOS compared to those born after preterm labor. Late-onset sepsis risk differs according to the cause of preterm birth. Compared with those born after preterm labor, infants born very preterm because of hypertensive disorders of pregnancy and/or fetal growth restriction display an increased risk for late-onset sepsis. Antenatal factors, in particular the full spectrum of causes leading to preterm birth, should be taken into consideration to better prevent and manage neonatal infectious morbidity and inform the parents.