产时发热峰值及发热持续时间对母婴围产期不良结局的影响

张佩丽; 胡鹏; 郭静宜; 林华亮

doi:10.16462/j.cnki.zhjbkz.2024.08.006

产时发热峰值及发热持续时间对母婴围产期不良结局的影响

doi: 10.16462/j.cnki.zhjbkz.2024.08.006

张佩丽^{1, 2},
胡鹏¹,
郭静宜³,
林华亮^1, ,

1.
中山大学公共卫生学院流行病学系，广州 510080
2.
汕头市中心医院妇产科，汕头 515031
3.
广州市第一人民医院感染管理科，广州 510180

基金项目:

广东省自然科学基金 2022A1515010420

国家自然科学基金 81972993

详细信息

通讯作者:
林华亮，E-mail : linhualiang@mail.sysu.edu.cn

中图分类号: R714;R181.1
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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-05
- 修回日期: 2024-05-16
- 网络出版日期: 2024-09-29
- 刊出日期: 2024-08-10

The impact of peak and duration of intrapartum fever on adverse perinatal maternal and neonatal outcomes

ZHANG Peili^{1, 2},
HU Peng¹,
GUO Jingyi³,
LIN Hualiang^{1
, ,}

1.
Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
2.
Department of Gynaecology and Obstetrics, Shantou Central Hospital, Shantou 515031, China
3.
Administration Department of Nosocomial Infection, Guangzhou First People′s Hospital, Guangzhou 510180, China

Funds:

National Science Foundation of Guangdong Province, China 2022A1515010420

National Natural Science Foundation of China 81972993

More Information

Corresponding author: LIN Hualiang, E-mail : linhualiang@mail.sysu.edu.cn

摘要

摘要: 目的探讨母体产时发热体温峰值和发热持续时间对母婴围产期结局的影响。方法选取2020―2022年在汕头市中心医院妇产科分娩的足月单胎初产妇，以产时发热(母体体温≥37.5 ℃)为暴露因素，分别以发热峰值T_max(产时能记录到的最高体温)、发热持续时间t(从首次记录发热到首次记录正常体温或分娩为止的时间)，发热复合变量$\[v\left[ {v = \frac{{{T_{max}} - 37℃}}{{100}} \times t} \right]\]$分组。比较新生儿围产期不良结局(包括新生儿窒息、新生儿感染、缺血缺氧性脑病、惊厥、颅内出血等)和孕产妇围产期不良结局(包括母体手术产、产后出血、手术切口感染、产褥期败血症)差异。采用多因素logistic回归分析模型分析母体产时发热峰值及发热持续时间与母婴围产期不良结局之间的关联。结果本研究共纳入2197例研究对象，其中307名(13.9%)产妇在分娩期间出现发热。与非发热组相比，发热组新生儿不良结局及母体手术产发生风险升高。在调整混杂因素后，发热峰值每增加1 ℃，新生儿不良结局发生风险增加1.204倍(OR=2.204, 95% CI: 1.691~2.423)，母体手术产发生风险增加88.3%(OR=1.883, 95% CI: 1.581~2.242);发热持续时间每增加60 min，新生儿不良结局发生风险增加28.4%(OR=1.284, 95% CI: 1.178~1.400)，母体手术产发生风险增加29.4%(OR=1.294, 95% CI: 1.183~1.414);发热复合变量每增加1个单位，新生儿不良结局发生风险增加55.4%(OR=1.554, 95% CI: 1.359~1.777)，母体手术产发生风险增加49.4%(OR=1.494, 95% CI: 1.298~1.720)。结论随着发热峰值的升高，发热持续时间增加，发热复合变量增加，新生儿不良结局及母体手术产发生风险均增加。
- 产时发热 /
- 发热峰值 /
- 发热持续时间 /
- 母体结局 /
- 新生儿不良结局 /
- 母体手术产
Abstract: Objective To explore the impact of maternal intrapartum fever′s peak and duration on perinatal outcomes. Methods This study included primiparas who delivered at term with a singleton fetus in the Shantou Central Hospital from 2020 to 2022. The exposure factor was intrapartum fever (the maternal body temperature ≥37.5 ℃). The participants were grouped based on different fever peak (Tmax, the highest recorded body temperature during labor), fever duration (t, the time from the first recorded fever to the first recorded normal body temperature or delivery), and fever composite variable v, $ \[\left[ {v = \frac{{{T_{max}} - 37℃}}{{100}} \times t} \right]\]$. The study compared the differences in neonatal outcomes (including neonatal asphyxia, neonatal infections, hypoxic-ischemic encephalopathy, seizures, intracranial hemorrhage, etc.) and adverse perinatal outcomes of pregnant women (including maternal operative delivery, postpartum hemorrhage, incision infection, puerperal sepsis). Logistic regression analysis was conducted to assess the association between the peak and duration of intrapartum fever and adverse perinatal outcomes. Results A total of 2 197 parturients were included in the study, and 307 (13.9%) of them had intrapartum fever. Compared with afebrile parturients, febrile parturients had higher rates of neonatal adverse outcomes and maternal operative delivery. After adjusting for confounding factors, for every 1 ℃ increase in fever peak, the risk of adverse neonatal outcomes increased by 1.204 times (OR =2.204, 95% CI: 1.691-2.423), and the risk of maternal operative delivery increased by 88.3% (OR =1.883, 95% CI: 1.581-2.242);for every 60-minute increase in the duration of fever, the risk of adverse neonatal outcomes increased by 28.4% (OR =1.284, 95% CI: 1.178-1.400), and the risk of maternal operative delivery increased by 29.4% (OR =1.294, 95% CI: 1.183-1.414);for every 1 unit increase in the composite variable of fever, the risk of adverse neonatal outcomes increased by 55.4% (OR =1.554, 95% CI: 1.359-1.777), and the risk of maternal operative delivery increased by 49.4% (OR =1.494, 95% CI: 1.298-1.720). Conclusions Increased peak fever, increased duration of fever, and increased composite fever variables were associated with higher risk of adverse neonatal outcomes and maternal operative delivery.
- Intrapartum fever /
- Fever peak /
- Fever duration /
- Maternal outcomes /
- Adverse neonatal outcomes /
- Maternal operative delivery

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表 1 发热组与非发热组母婴临床资料比较

Table 1. Comparison of maternal and neonatal clinical data between febrile group and afebrile group

变量Variable	发热组Febrile group^① (n=307)	非发热组Afebrile group^① (n=1 890)	χ²/t值value	P值value
年龄/岁Age/years	28.18±3.53	27.80±3.69	-1.644	0.100
孕周/周Gestational age /weeks	39.60±1.03	39.34±1.05	-4.061	＜0.001
分娩镇痛Epidural analgesia	261(85.02)	1 038(54.92)	98.981	＜0.001
胎膜早破Premature rupture of membranes	161(52.44)	721(38.15)	22.459	＜0.001
生殖道GBS检测阳性GBS-positive	31(10.10)	175(9.26)	0.219	0.640
妊娠期糖尿病Gestational diabetes mellitus	68(22.15)	345(18.25)	2.626	0.105
妊娠期高血压疾病Hypertensive disorders of pregnancy	28(9.12)	164(8.70)	0.065	0.799
男胎Male fetus	171(55.70)	937(49.60)	3.962	0.047
新生儿体重Neonatal birthweight /kg	3.26±0.35	3.09±0.38	-7.804	＜0.001
新生儿头围Neonatal head circumference /cm	33.43±1.25	33.06±1.27	-4.753	＜0.001
羊水粪染Meconium-stained amniotic fluid	97(31.60)	355(18.78)	26.534	＜0.001
注：GBS，生殖道B族链球菌。 ①以人数(占比/%)或x±s表示。 Note: GBS, Group B streptococcus. ① Number of people (proportion/%) or x±s.

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表 2 发热组与非发热组母婴不良结局差异

Table 2. Differences in adverse maternal and neonatal outcomes between the febrile and afebrile groups

变量Variable	发热组Febrile group^① (n=307)	非发热组Afebrile group^① (n=1 890)	χ²/t值value	P值value
新生儿缺血缺氧脑病Neonatal hypoxic-ischemic encephalopathy	3(1.00)	24(1.30)	0.023	0.879
新生儿肺炎Neonatal pneumonia	18(5.86)	60(3.17)	5.575	0.018
新生儿非典型感染Neonatal uncharacterized infection	87(28.33)	204(10.79)	70.750	＜0.001
新生儿窒息Neonatal asphyxia	8(2.61)	26(1.40)	1.878	0.171
新生儿败血症Neonatal septicemia	1(0.33)	3(0.16)	0.000	1.000
新生儿坏死性小肠结肠炎Neonatal necrotizing enterocolitis	1(0.33)	2(0.11)	0.018	0.893
新生儿颅内出血Neonatal intracranial hemorrhage	9(2.93)	58(3.07)	0.017	0.897
新生儿惊厥Neonatal seizures	0(0)	2(0.11)	0.000	1.000
新生儿不良结局Adverse neonatal outcome	114(37.13)	311(16.46)	72.380	＜0.001
产后出血Postpartum hemorrhage	30(9.77)	179(9.47)	0.028	0.868
手术产Maternal operative delivery	169(55.04)	515(27.24)	95.199	＜0.001
产褥期败血症Puerperal sepsis	2(0.65)	1(0.05)	3.244	0.072
母体切口感染Maternal incision infection	5(1.63)	10(0.53)	3.227	0.072
注：①以人数(占比/%)表示。 Note: ① Number of people (proportion/%).

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表 3 发热峰值、发热持续时间和发热复合变量与新生儿不良结局发生风险的关系

Table 3. Association of peak fever, duration of fever, and composite variables of fever with the risk of adverse neonatal outcomes

发热变量Variables of fever	人数Number of people	病例数Number of cases	OR值value (95% CI)	P值value	OR值value (95% CI)^①	P值value
发热峰值Peak fever/℃
无发热Afebrile	1 890	311	1.000		1.000
37.5 ~＜38.0	183	53	2.070(1.471~2.913)	＜0.001	1.820(1.275~2.599)	0.001
38.0~＜38.5	90	40	4.062(2.634~6.264)	＜0.001	3.441(2.187~5.414)	＜0.001
38.5~＜39.0	24	16	10.154(4.308~23.933)	＜0.001	8.498(3.483~20.732)	＜0.001
≥39.0	10	5	5.077(1.461~17.642)	0.011	4.765(1.297~17.512)	0.019
每升高1 ℃ For every 1 ℃ increase			2.207(1.857~2.624)	＜0.001	2.204(1.691~2.423)	＜0.001
发热持续时间Duration of fever /min
无发热Afebrile	1 890	311	1.000		1.000
0~＜60	101	30	2.145(1.376~3.344)	0.001	1.903(1.198~3.020)	0.006
60~＜120	83	39	4.500(2.876~7.043)	＜0.001	3.760(2.352~6.011)	＜0.001
120~＜180	42	14	2.539(1.321~4.877)	0.005	1.956(0.992~3.858)	0.053
≥180	81	31	3.148(1.979~5.008)	＜0.001	2.962(1.825~4.807)	＜0.001
每升高60 min For every 60-minute increase			1.325(1.217~1.442)	＜0.001	1.284(1.178~1.400)	＜0.001
发热复合变量Composite variables of fever
无发热Afebrile	1 890	311	1.000		1.000
0~＜0.438	76	24	2.343(1.423~3.859)	0.001	2.057(1.223~3.461)	0.007
0.438~＜0.833	77	25	2.441(1.492~3.993)	＜0.001	2.167(1.297~3.621)	0.003
0.833~＜1.960	78	30	3.173(1.979~5.088)	＜0.001	2.632(1.604~4.316)	＜0.001
≥1.960	76	35	4.334(2.717~6.915)	＜0.001	3.815(2.344~6.210)	＜0.001
每增加1个单位For every 1 unit increase			1.625(1.423~1.855)	＜0.001	1.554(1.359~1.777)	＜0.001
注：①调整孕周、年龄、分娩镇痛、胎膜早破、新生儿体重、头围、羊水粪染。 Note: ① Models were adjusted by gestational week, age, epidural analgesia, premature rupture of membranes, neonatal birthweight, neonatal head circumference, meconium-stained amniotic fluid.

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表 4 发热峰值、发热持续时间和发热复合变量与母体手术产发生风险的关系

Table 4. Association of peak fever, duration of fever, and composite variables of fever with the risk of maternal operative delivery

发热变量Variables of fever	人数Number of people	病例数Number of cases	OR值value (95% CI)	P值value	OR值value (95% CI)^①	P值value
发热峰值Peak fever/℃
无发热Afebrile	1 890	515	1.000		1.000
37.5~＜38.0	183	98	3.078(2.263~4.187)	＜0.001	2.754(1.982~3.827)	＜0.001
38.0~＜38.5	90	49	3.191(2.082~4.891)	＜0.001	2.577(1.639~4.053)	＜0.001
38.5~＜39.0	24	17	6.484(2.673~15.727)	＜0.001	5.227(2.103~12.991)	＜0.001
≥39.0	10	5	2.670(0.770~9.261)	0.122	2.291(0.633~8.284)	0.206
每升高1 ℃ For every 1 ℃ increase			2.175(1.838~2.573)	＜0.001	1.883(1.581~2.242)	＜0.001
发热持续时间Duration of fever/min
无发热Afebrile	1 890	515	1.000		1.000
0~＜60	101	49	2.516(1.681~3.765)	＜0.001	2.197(1.430~3.376)	＜0.001
60~＜120	83	53	4.717(2.980~7.465)	＜0.001	4.032(2.495~6.518)	＜0.001
20~＜180	42	20	2.427(1.314~4.485)	0.005	1.886(0.996~3.573)	0.052
≥180	81	47	3.691(2.347~5.804)	＜0.001	3.307(2.048~5.340)	＜0.001
每升高60 min For every 60-minute increase			1.374(1.256~1.503)	＜0.001	1.294(1.183~1.414)	＜0.001
发热复合变量Composite variables of fever
无发热Afebrile	1 890	515	1.000		1.000
0~＜0.438	76	36	2.403(1.515~3.812)	＜0.001	2.038(1.246~3.333)	0.005
0.438~＜0.833	77	47	4.183(2.617~6.686)	＜0.001	3.965(2.431~6.468)	＜0.001
0.833~＜1.960	78	41	2.959(1.876~4.667)	＜0.001	2.375(1.468~3.842)	＜0.001
≥1.960	76	45	3.876(2.426~6.192)	＜0.001	3.265(1.992~5.353)	＜0.001
每增加1个单位For every 1 unit increase			1.631(1.417~1.877)	＜0.001	1.494(1.298~1.720)	＜0.001
注：①调整孕周、年龄、分娩镇痛、胎膜早破、新生儿体重、头围、羊水粪染。 Note: ① Models were adjusted by gestational week, age, epidural analgesia, premature rupture of membranes, neonatal birthweight, neonatal head circumference, meconium-stained amniotic fluid.

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