Objective: To investigate the clinical characteristics of early term and full term neonates, and analyze the risk factors associated with short term outcomes in early term neonates. Method: Neonates with birth weight (BW) ≥2 500 g from year 2013 were analyzed retrospectively based on American Congress of Obstericians & Gynecologists (ACOG) latest definition of term infants. According to inclusion and exclusion criteria, early term (gestational age 37-38 weeks) and full term(gestational age 39-40 weeks) neonates were included, whose morbidity constituent proportion was analyzed by χ(2) test or Fisher accuracy test or t test or Wilcoxon test. Risk factors associated with short term outcomes in early term population were analyzed by Logistic regression analysis. Result: There were 3 002 discharged term infants being investigated, among whom 1 303 cases were included(768 males and 535 females), and 37, 38, 39 and 40 weeks' gestational age newborns were 160, 324, 450 and 369 respectively. Compared with full term neonates(n=819), early term neonates (n=484) had longer length of hospital stay (LOS)(6.0(5.0, 9.0) vs. 6.0(4.0, 8.0), Z=2.830, P=0.005), higher usage rate of intravenous antibiotics(86.4%(418/484) vs. 80.1%(656/819), χ(2)=8.009, P=0.005), higher assisted ventilation rate(9.5%(46/484) vs. 2.9%(24/819), χ(2)=25.528, P<0.01), higher pulmonary surfactant administration rate(4.3%(21/484) vs. 1.1%(9/819), χ(2)=14.006, P<0.01), as well as higher hypoglycemia incidence(3.9%(19/484) vs. 1.2%(10/819), χ(2)=10.226, P=0.001). There were no statistically significant differences in 1 min Apgar score (9(9, 10)vs. 9(9, 10), Z=0.860, P=0.390), 5 min Apgar score (10(9, 10) vs. 10(9, 10), Z=0.810, P=0.418), white blood cell count (15 (11, 21) ×10(9) /L vs.15 (11, 22) ×10(9) /L, Z=0.880, P=0.379), hemoglobin count(180 (159, 205) vs. 182 (160, 204) g/L, Z=0.560, P=0.576), or platelet count(303(234, 372) ×10(9)/L vs. 301(237, 391) ×10(9)/L, Z=0.550, P=0.584). BW between 2 500 g and 2 999 g(OR 1.69, 95% CI: 1.10-2.62, χ(2) =5.614, P=0.018), wet lung(OR=2.61, 95% CI: 1.61-4.24, χ(2)=15.023, P=0.000)and pneumonia(OR 1.88, 95% CI: 1.14-3.08, χ(2)=6.192, P=0.013) were risk factors in early term neonates' short term adverse outcomes. Conclusion: Early term newborns are still at their "immature" state, and respiratory disorders are major risk factors associated with short term outcomes. Hence, early delivery during 37-38 weeks should be avoided as possible as we can.
目的：探讨住院治疗的早期足月儿的临床特征及其近期预后的危险因素。 方法：通过对2013年复旦大学附属儿科医院新生儿科及新生儿重症监护室住院治疗的生后14 d内出生体重≥2 500 g的新生儿出院病历信息按照美国妇产科医师协会最新足月儿分类进行横断面回顾性调查分析。按照设定的入选标准及排除标准，分为早期足月儿组(出生胎龄37～38周)和完全足月儿组(出生胎龄39～40周)。组间比较采用χ(2)检验、Fisher准确性检验、t检验或Wilcoxon秩和检验。早期足月儿预后评估采用Logistic回归分析。 结果： 2013年住院治疗≥2 500 g新生儿共3 002例，按照入选和排除标准最终纳入1 303例，其中男768例、女535例；出生胎龄37周160例，38周324例，39周450例，40周369例。早期足月儿(484例)与完全足月儿(819例)组相比住院天数更长[6.0(5.0，9.0)比6.0(4.0，8.0)，Z＝2.830，P＝0.005]，静脉抗生素使用率更高[86.4%(418/484)比80.1%(656/819)，χ(2) ＝8.009，P＝0.005]，肺泡表面活性物质使用率更高[4.3%(21/484)比1.1%(9/819)，χ(2) ＝14.006，P<0.01]，辅助通气率更高[9.5%(46/484)比2.9%(24/819)，χ(2) ＝25.528, P<0.01]，低血糖发生率更高[3.9%(19/484)比1.2%(10/819)，χ(2) ＝10.226, P＝0.001]。而早期足月儿与完全足月儿在1 min Apgar评分[9 (9, 10)比9(9, 10), Z＝0.860，P＝0.390]，5 min Apgar评分[10(9, 10)比10(9, 10), Z＝0.810，P＝0.418]，白细胞计数[15(11, 21)×10(9)/L比15(11，22)×10(9) /L，Z＝0.880，P＝0.379]，血红蛋白值[180(159, 205)比182(160, 204)g/L，Z＝0.560，P＝0.576]，血小板计数[303(234, 372)×10(9) /L比301(237, 391)×10(9) /L，Z＝0.550，P＝0.584]等方面差异均无统计学意义。早期足月儿近期预后的危险因素为出生体重偏低[2 500～2 999 g，比值比(OR)1.69，95%可信区间(CI)：1.10～2.62，χ(2)＝5.614，P＝0.018]，湿肺(OR 2.61，95% CI：1.61～4.24，χ(2)＝15.023，P＝0.000)，肺炎(OR 1.88，95% CI：1.14～3.08，χ(2) ＝6.192，P＝0.013)。 结论：早期足月儿仍处于一个相对未成熟状态，呼吸道疾病是影响早期足月儿近期预后的主要因素，应尽可能避免孕37～38周分娩。.
Keywords: Prognosis; Risk factors; Term birth.