Objective: To explore the risk factors for endotracheal intubation during resuscitation in the delivery room among very preterm infants.
Methods: A retrospective analysis was performed for 455 very preterm infants who were admitted to the neonatal intensive care unit from January 2017 to December 2019. They were divided into an intubation group (n=79) and a non-intubation group (n=376) according to whether endotracheal intubation was performed during resuscitation. The risk factors for endotracheal intubation during resuscitation were evaluated by multivariate logistic regression analysis.
Results: The intubation rate was 17.4% (79/455). Compared with the intubation group, the non-intubation group had significantly higher gestational age, birth weight, and rates of caesarean birth, delayed cord clamping (DCC), resuscitation quality improvement, regular use of antenatal glucocorticoids in mothers and premature rupture of membranes > 18 hours (P < 0.05), but significantly lower rates of maternal gestational diabetes mellitus, placental abruption, placenta previa or placenta previa status, and maternal thyroid dysfunction (P < 0.05). Regular use of antenatal glucocorticoids in mothers (OR=0.368, P < 0.05) and DCC (OR=0.222, P < 0.05) were protective factors against intubation during resuscitation, while younger gestational age, birth weight < 750 g, maternal gestational diabetes mellitus, and placenta previa or placenta previa status were risk factors for intubation during resuscitation (P < 0.05).
Conclusions: Very preterm infants with younger gestational age, birth weight < 750 g, maternal diabetes mellitus, placenta previa or placenta previa status may have a higher risk for endotracheal intubation after birth. The regular use of antenatal glucocorticoids and DCC can reduce the risk of intubation during resuscitation in very preterm infants.
结果: 极早产儿中复苏时插管发生率为17.4%（79/455）。非插管组胎龄、出生体重及剖宫产出生、延迟脐带结扎（DCC）、出生时间在复苏质量改进后、孕母产前足疗程使用糖皮质激素、胎膜早破> 18 h的比例高于插管组（P < 0.05），而孕母妊娠糖尿病、胎盘早剥、前置胎盘或胎盘前置状态及甲状腺功能异常比例低于插管组（P < 0.05）。孕母产前足疗程使用糖皮质激素和DCC是极早产儿复苏时插管的保护因素（分别OR=0.368、0.222，P < 0.05），而胎龄小、出生体重 < 750 g、孕母妊娠糖尿病、前置胎盘或胎盘前置状态是极早产儿复苏时插管的危险因素（P < 0.05）。
结论: 对胎龄小、预估出生体重 < 750 g、孕母妊娠糖尿病、前置胎盘或胎盘前置状态的极早产儿，分娩时应该做好气管插管的充分准备；孕母产前足疗程使用糖皮质激素和DCC应用能够降低极早产儿复苏时插管风险，值得临床推广。