Clinical application of neonatal critical illness score

doi:10.3877/cma.j.issn.1673-5250.2017.02.008

Objective

To investigate the significance of neonatal critical illness score (NCIS)(Draft) for treating critically ill neonates.

Methods

A total of 581 cases of critically ill neonates who were treated in Department of Neonatology, Bazhong Central Hospital of Sichuan Province from May 2012 to May 2015 were selected as research subjects. All the 581 cases met the neonatal critical cases diagnostic criteria in NCIS (Draft) and their clinical data were collected by retrospective method. The single index that matched the index of critically ill neonates of NCIS (Draft) and the score points of inspection items of NCIS for critically ill neonates whose NCIS score ≤90 points were statistically analyzed. According to the prognosis of the 581 cases, they were enrolled into good prognosis group (n=445), and poor prognosis group (n=136). The clinical data between two groups were statistically analyzed. Combined with the results of existing researches and clinical practice, some factors were introduced into multivariate unconditional logistic regression analysis to analyzed the prognostic factors of critically ill neonates.

Results

①Among the 581 cases of critically ill neonates, the number of male neonates was higher than female neonates (370∶211). Most neonates were born in 1 d (420 cases, 72.3%), and there were more neonates via cesarean section than those via vaginal delivery (337∶244). And 54.7% (318/581) neonates had at least one high risk factor. The first three diseases of critically ill neonates were neonatal respiratory distress syndrome (NRDS) (32.4%, 188/581), neonatal pneumonia (22.7%, 132/581), and neonatal asphyxia (15.8%, 92/581). ②Among the 581 cases of critically ill neonates, 455 cases (78.3%) were diagnosed as neonatal critical cases by single index of NCIS (Draft), which were mostly presented as requiring tracheal intubation or repeating apnea without response to stimulation (59.3%, 270/455), severe hyper bilirubinemia (16.7%, 76/455), and hypoglycemia (10.1%, 46/455). Among the 581 cases of critically ill neonates, 585 cases (96.0%) were diagnosed as neonatal critical cases by NCIS score ≤ 90 points. And the first three inspection items with most easily deducted were pH value ≤7.25 or ≥7.50 (31.5%, 176/558), respiratory rate ≤ 25 time/min or ≥ 60 time/min (18.1%, 101/558), and partial pressure of oxygen in artery (PaO₂) ≤ 60 mmHg (1 mmHg=0.133 kPa) (16.8%, 94/558). ③There were no statistical differences between good prognosis group and poor prognosis group in the gender ratio, onset age, and gestational age (P>0.05). Compared with poor prognosis group, the birth weight in good prognosis group was heavier, the hospitalization time was longer, cesarean delivery rate was higher, but the proportion of very critical newborns (NCIS score< 70 points) in good prognosis group was lower, and all the differences were statistically significant (P<0.05). ④The results of multivariate unconditional logistic regression analysis indicated that birth weight, hospitalization time and NCIS score were independent factors affecting the prognosis of critically ill newborns (OR=2.528, 95%CI: 1.178-5.426, P=0.017; OR=76.736, 95%CI: 27.279-215.858, P<0.001; OR=106.697, 95%CI: 43.952-259.019, P<0.001).

Conclusions

The single index and NCIS score in NCIS (Draft) can reflect the state of neonatal lesions accurately and effectively. So this method can guide the treatment and prognosis assessment of critically ill newborns and is beneficial for building referral mechanism in primary hospital and emergency access for critical neonates. Thus it can improve the rate of successful rescue and reduce the mortality rate of critically ill neonates.

Key words: Critical illness, Neonatal critical illness score, Prognosis, Clinical application, Infant, newborn

表1 581例危重新生儿基本临床资料分析结果[例数(%)]

项目		构成比	项目		构成比
性别			高危因素合并情况		?
?	男	370(63.7)	?	母亲因素	138(23.7)
?	女	211(36.3)	?	产时因素	98(16.9)
发病日龄(d)			?	胎儿因素	82(14.1)
?	<1	420(72.3)	?	未合并高危因素	263(45.3)
?	≥1～7	78(13.4)	危重疾病构成		?
?	≥7～28	83(14.3)		NRDS	188(32.4)
分娩方式			?	新生儿肺炎	132(22.7)
?	剖宫产分娩	337(58.0)	?	新生儿窒息	92(15.8)
?	经阴道分娩	244(42.0)	?	新生儿败血症	44(7.6)
分娩胎龄(周)			?	出生缺陷	40(6.9)
?	<37	247(43.7)	?	新生儿溶血病或危重黄疸	33(5.7)
?	≥37	334(57.5)	?	新生儿肺出血	18(3.1)
出生体重(g)			?	新生儿硬肿症	15(2.6)
?	≤1 000	8(1.4)	?	新生儿休克	10(1.7)
?	>1 000～1 500	51(8.8)	?	其他	9(1.5)
?	>1 500～2 500	208(35.8)	预后		?
?	>2 500	314(54.0)	?	治愈或好转	445(76.6)
住院时间(d)			?	死亡或放弃治疗后死亡	136(23.4)
?	<7	252(43.4)	?		?
?	≥7	329(56.6)	?		?

表1 581例危重新生儿基本临床资料分析结果[例数(%)]

项目		构成比	项目		构成比
性别			高危因素合并情况		?
?	男	370(63.7)	?	母亲因素	138(23.7)
?	女	211(36.3)	?	产时因素	98(16.9)
发病日龄(d)			?	胎儿因素	82(14.1)
?	<1	420(72.3)	?	未合并高危因素	263(45.3)
?	≥1～7	78(13.4)	危重疾病构成		?
?	≥7～28	83(14.3)		NRDS	188(32.4)
分娩方式			?	新生儿肺炎	132(22.7)
?	剖宫产分娩	337(58.0)	?	新生儿窒息	92(15.8)
?	经阴道分娩	244(42.0)	?	新生儿败血症	44(7.6)
分娩胎龄(周)			?	出生缺陷	40(6.9)
?	<37	247(43.7)	?	新生儿溶血病或危重黄疸	33(5.7)
?	≥37	334(57.5)	?	新生儿肺出血	18(3.1)
出生体重(g)			?	新生儿硬肿症	15(2.6)
?	≤1 000	8(1.4)	?	新生儿休克	10(1.7)
?	>1 000～1 500	51(8.8)	?	其他	9(1.5)
?	>1 500～2 500	208(35.8)	预后		?
?	>2 500	314(54.0)	?	治愈或好转	445(76.6)
住院时间(d)			?	死亡或放弃治疗后死亡	136(23.4)
?	<7	252(43.4)	?		?
?	≥7	329(56.6)	?		?

表2 455例单项指标符合《NCIS(草案)》新生儿危重病例诊断标准的危重新生儿的单项指标分析结果[例数(%)]

单项指标	构成比
需进行气管插管辅助机械通气治疗或反复呼吸暂停对刺激无反应	270(59.3)
有换血指征的高胆红素血症	76(16.7)
血糖<1.1 mmol/L(20 mg/dL)	46(10.1)
弥散性血管内凝血	18(4.0)
昏迷，弹足底5次无反应	14(3.1)
反复抽搐，经处理，抽搐仍持续24 h以上不能缓解	10(2.2)
出生体重≤1 000 g	8(1.7)
严重心律紊乱，如阵发性室上性心动过速合并心力衰竭、心房扑动和心房纤颤、阵发性室性心动过速、心室扑动和纤颤、房室传导阻滞(≥Ⅱ度)、心室内传导阻滞(双束支以上)	5(1.1)
硬肿面积≥70%	4(0.9)
体温≤30 ℃或>41 ℃	4(0.9)
合计	455(100.0)

表2 455例单项指标符合《NCIS(草案)》新生儿危重病例诊断标准的危重新生儿的单项指标分析结果[例数(%)]

单项指标	构成比
需进行气管插管辅助机械通气治疗或反复呼吸暂停对刺激无反应	270(59.3)
有换血指征的高胆红素血症	76(16.7)
血糖<1.1 mmol/L(20 mg/dL)	46(10.1)
弥散性血管内凝血	18(4.0)
昏迷，弹足底5次无反应	14(3.1)
反复抽搐，经处理，抽搐仍持续24 h以上不能缓解	10(2.2)
出生体重≤1 000 g	8(1.7)
严重心律紊乱，如阵发性室上性心动过速合并心力衰竭、心房扑动和心房纤颤、阵发性室性心动过速、心室扑动和纤颤、房室传导阻滞(≥Ⅱ度)、心室内传导阻滞(双束支以上)	5(1.1)
硬肿面积≥70%	4(0.9)
体温≤30 ℃或>41 ℃	4(0.9)
合计	455(100.0)

表3 558例NCIS评分≤90分符合《NCIS(草案)》新生儿危重病例诊断标准的危重新重儿的NCIS检查项目扣分情况[例数(%)]

检查项目	扣4分	扣6分	合计
pH值≤7.25或≥7.50	138(24.7)	38(6.8)	176(31.5)
呼吸频率≤25次/min或≥60次/min	89(15.9)	12(2.2)	101(18.1)
PaO₂≤60 mmHg	82(14.7)	12(2.1)	94(16.8)
胃肠道表现，如腹胀或消化道出血	35(6.3)	10(1.8)	45(8.1)
心率≤100次/min或≥160次/min	21(3.8)	18(3.2)	39(7.0)
血Na^＋浓度≤130 mmol/L或≥150 mmol/L	22(4.0)	4(0.7)	26(4.7)
血压：收缩压≤50 mmHg或≥90 mmHg	20(3.6)	4(0.7)	24(4.3)
血清肌肝浓度<87.0 mol/L或≥114.0 mol/L，或血清尿素氮浓度≥7.1 mmol/L	13(2.3)	6(1.1)	19(3.4)
血细胞比容≤0.4	14(2.5)	5(0.9)	19(3.4)
血K^＋浓度≤2.9 mmol/L或≥7.5 mmol/L	13(2.3)	2(0.4)	15(2.7)
合计	447(80.1)	111(19.9)	558(100.0)

表3 558例NCIS评分≤90分符合《NCIS(草案)》新生儿危重病例诊断标准的危重新重儿的NCIS检查项目扣分情况[例数(%)]

检查项目	扣4分	扣6分	合计
pH值≤7.25或≥7.50	138(24.7)	38(6.8)	176(31.5)
呼吸频率≤25次/min或≥60次/min	89(15.9)	12(2.2)	101(18.1)
PaO₂≤60 mmHg	82(14.7)	12(2.1)	94(16.8)
胃肠道表现，如腹胀或消化道出血	35(6.3)	10(1.8)	45(8.1)
心率≤100次/min或≥160次/min	21(3.8)	18(3.2)	39(7.0)
血Na^＋浓度≤130 mmol/L或≥150 mmol/L	22(4.0)	4(0.7)	26(4.7)
血压：收缩压≤50 mmHg或≥90 mmHg	20(3.6)	4(0.7)	24(4.3)
血清肌肝浓度<87.0 mol/L或≥114.0 mol/L，或血清尿素氮浓度≥7.1 mmol/L	13(2.3)	6(1.1)	19(3.4)
血细胞比容≤0.4	14(2.5)	5(0.9)	19(3.4)
血K^＋浓度≤2.9 mmol/L或≥7.5 mmol/L	13(2.3)	2(0.4)	15(2.7)
合计	447(80.1)	111(19.9)	558(100.0)

表4 预后良好组与预后不良组危重新生儿的临床资料比较

组别	例数	性别[例数(%)]		发病日龄[例数(%)]			出生体重 [g，M(P₂₅～P₇₅)]	住院时间[d， M(P₂₅～P₇₅)]
组别	例数	男	女	<1 d	≥1～7 d	≥7～28 d	出生体重 [g，M(P₂₅～P₇₅)]	住院时间[d， M(P₂₅～P₇₅)]
预后良好组	445	283(63.6)	162(36.4)	315(70.8)	66(14.8)	64(14.4)	2 550.0(2 100.0～3 100.0)	10(6～15)
预后不良组	136	87(64.0)	49(36.0)	105(77.2)	12(8.8)	19(14.0)	2 400.0(1 612.5～3 027.5)	1(1～2)
检验值	?	χ²＝0.006		χ²＝3.407			Z＝－2.709	Z＝－15.769
P值	?	0.937		0.182			0.007	<0.001
组别	例数	分娩方式[例数(%)]		分娩胎龄[例数(%)]		NCIS评分[例数(%)]
组别	例数	剖宫产分娩	经阴道分娩	≥37周	<37周	70～90分	<70分
预后良好组	445	276(62.0)	169(38.0)	257(57.8)	188(42.2)	403(90.6)	42(9.4)
预后不良组	136	61(44.9)	75(55.1)	77(56.6)	59(43.4)	19(14.0)	117(86.0)
检验值	?	χ²＝12.606		χ²＝0.055		χ²＝307.414
P值	?	<0.001		0.815		<0.001

表4 预后良好组与预后不良组危重新生儿的临床资料比较

组别	例数	性别[例数(%)]		发病日龄[例数(%)]			出生体重 [g，M(P₂₅～P₇₅)]	住院时间[d， M(P₂₅～P₇₅)]
组别	例数	男	女	<1 d	≥1～7 d	≥7～28 d	出生体重 [g，M(P₂₅～P₇₅)]	住院时间[d， M(P₂₅～P₇₅)]
预后良好组	445	283(63.6)	162(36.4)	315(70.8)	66(14.8)	64(14.4)	2 550.0(2 100.0～3 100.0)	10(6～15)
预后不良组	136	87(64.0)	49(36.0)	105(77.2)	12(8.8)	19(14.0)	2 400.0(1 612.5～3 027.5)	1(1～2)
检验值	?	χ²＝0.006		χ²＝3.407			Z＝－2.709	Z＝－15.769
P值	?	0.937		0.182			0.007	<0.001
组别	例数	分娩方式[例数(%)]		分娩胎龄[例数(%)]		NCIS评分[例数(%)]
组别	例数	剖宫产分娩	经阴道分娩	≥37周	<37周	70～90分	<70分
预后良好组	445	276(62.0)	169(38.0)	257(57.8)	188(42.2)	403(90.6)	42(9.4)
预后不良组	136	61(44.9)	75(55.1)	77(56.6)	59(43.4)	19(14.0)	117(86.0)
检验值	?	χ²＝12.606		χ²＝0.055		χ²＝307.414
P值	?	<0.001		0.815		<0.001

表5 危重新生儿预后影响因素的多因素非条件logistic回归分析的变量含义及其赋值情况

自变量/应变量	变量名	赋值
预后	Y	Y＝1表示经治疗后死亡或放弃治疗后死亡，Y＝0表示治愈或好转
出生体重	X₁	X₁＝1表示出生体重≤2 500 g，X₁＝0表示出生体重>2 500 g
分娩方式	X₂	X₂＝1表示经阴道分娩，X₂＝0表示剖宫产分娩
住院时间	X₃	X₃＝1表示NCIS评分<70分，X₃＝0表示NCIS评分为70～90分
NCIS评分	X₄	X₄＝1表示住院时间<7 d，X₄＝0表示住院时间≥7 d

表5 危重新生儿预后影响因素的多因素非条件logistic回归分析的变量含义及其赋值情况

自变量/应变量	变量名	赋值
预后	Y	Y＝1表示经治疗后死亡或放弃治疗后死亡，Y＝0表示治愈或好转
出生体重	X₁	X₁＝1表示出生体重≤2 500 g，X₁＝0表示出生体重>2 500 g
分娩方式	X₂	X₂＝1表示经阴道分娩，X₂＝0表示剖宫产分娩
住院时间	X₃	X₃＝1表示NCIS评分<70分，X₃＝0表示NCIS评分为70～90分
NCIS评分	X₄	X₄＝1表示住院时间<7 d，X₄＝0表示住院时间≥7 d

表6 危重新生儿预后影响因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
出生体重	0.928	0.390	5.668	0.017	2.528	1.178～5.426
分娩方式	0.403	0.374	1.160	0.281	1.497	0.718～3.118
住院时间	4.340	0.528	67.654	<0.001	76.736	27.279～215.858
NCIS评分	4.670	0.453	106.506	<0.001	106.697	43.952～259.019
常数项	－6.871	0.684	100.911	<0.001	0.001	－

表6 危重新生儿预后影响因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
出生体重	0.928	0.390	5.668	0.017	2.528	1.178～5.426
分娩方式	0.403	0.374	1.160	0.281	1.497	0.718～3.118
住院时间	4.340	0.528	67.654	<0.001	76.736	27.279～215.858
NCIS评分	4.670	0.453	106.506	<0.001	106.697	43.952～259.019
常数项	－6.871	0.684	100.911	<0.001	0.001	－

[1]	中华医学会急诊学分会儿科学组，中华医学会儿科学分会急诊学组，中华医学会儿科学分会新生儿学组. 新生儿危重病例评分法(草案)[J]. 中华儿科杂志， 2001, 39(1): 42-43.
[2]	UNICEF. Levels and trends in child mortality 2014: report 2014. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation[M]. Geneva: World Health Organization, 2014: 1-30.
[3]	刘红，黄蕾，毛宝宏，等. 甘肃省2004－2011年新生儿死亡监测数据分析[J]. 中国新生儿科杂志， 2016, 31(4): 259-262.
[4]	付汉东，陆敏，杨树杰，等. 2007－2010年孝感地区新生儿死亡原因调查分析[J]. 中国当代儿科杂志， 2012, 14(3): 181-183.
[5]	姜岚. 537例住院新生儿死亡动态统计分析[J]. 中国妇幼保健， 2013, 28(17): 2761-2763.
[6]	童笑梅. 高危儿系统管理规范要略[J]. 中国新生儿科杂志， 2013, 28(3): 145-148.
[7]	Phibbs CS, Baker LC, Caughey AB, et al. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants[J]. N Engl J Med, 2007, 356(21): 2165-2175.
[8]	赖剑蒲，陈克正，吕回. 新生儿危重病例评分在NICU的应用分析[J]. 中国实用儿科杂志， 2003, 18(11): 658-660.
[9]	向二英，田鹏，余新华. 新生儿危重病例评分法在新生儿科的临床应用[J]. 湖北民族学院学报(医学版), 2013, 30(1): 52-53.
[10]	LuKonga E, Michelo C. Factors associated with neonatal mortality in the general population: evidence from the 2007 Zambia Demographic and Health Survey (ZDHS); a cross sectional study[J]. Pan Afr Med J, 2015, 20: 64.
[11]	柳国胜，聂川，谌崇峰. 新生儿呼吸生理特点[J]. 中国新生儿科杂志， 2013, 28(5): 289-291.
[12]	郭丽侠，杨宇艳. 母婴同室新生儿黄疸的早期监测与干预措施[J]. 中国妇幼保健， 2014, 29(15): 2363-2364.
[13]	郑明琼，王俊怡. 早产儿转运安全性分析[J]. 实用临床医学， 2014, 15(1): 86-88.
[14]	吴健容，谷强. 新生儿危重病例评分和第三代小儿死亡危险评分预测危重新生儿死亡风险比较[J]. 中国儿童保健杂志， 2014, 22(4): 368-370.
[15]	邱如新，杨莉. 新生儿危重病例评分与美国新生儿急性生理学评分围产期补充Ⅱ预测危重新生儿死亡风险比较[J]. 中国实用儿科杂志， 2012, 27(1): 42-44.
[16]	徐文慧，刘娜娜，柳涛，等. 改良aEEG、NCIS、SNAPPE-Ⅱ评分对高危儿脑损伤早期诊断价值比较[J]. 南昌大学学报(医学版), 2015, 55(2): 25-31.
[17]	王战胜，刘雨露，施雪颖，等. 不同评分系统预测危重新生儿死亡风险的应用[J]. 中国新生儿科杂志， 2016, 31(3): 189-192.

[1]	Yuezhou Li, Kongxi Zhang, Xiaohong Li, Zhonghua Shang. Prognostic significance of PUM in gastric carcinoma based on bioinformatics analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 426-432.
[2]	Jun Zhang, Zai Luo, Mingyu Duan, Zhengjun Qiu, Chen Huang. Research progress of prognostic prediction models for gastric cancer[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 456-461.
[3]	Qian Yang, Cuifang Li, Wanqiu Zhang. Analysis of short-term and long-term prognosis and influencing factors of primary liver cancer with spontaneous ruptured hemorrhage after emergency TACE surgery[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 33-36.
[4]	Yansong Li, Huimin Feng, Mingchao Liu, Zepeng Liu, Qiuxia Jiang. Expression and clinical significance of STIP1 in triple negative breast cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 52-56.
[5]	Zhenjian Jiang, Ming Jiang, Dali Huang. The expression and prognostic value of TK1 and Ki67 proteins in differentiated thyroid carcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 623-626.
[6]	Qingyan Yan, Xiaomei Yong, Hong Luo, Min Du. Prognostic factors and survival analysis of multicenter elderly patients with metastatic breast cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 636-638.
[7]	Xin Lu, Jiayi Xu, Yang Liu, Qin Yang, Wenwen Ju, Yinglong Xu. Comparison of the effects of early LC and PTCD continuous LC on liver function and prognosis of patients with acute cholecystitis[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 648-650.
[8]	Ming Jiang, Rui Luo, Chengchao Long. Diagnosis and treatment of obturator hernia: An experience of 73 cases over 10 years[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 706-710.
[9]	Bing Pan, Shaocheng Lyu, Xin Zhao, Lixin Li, Ren Lang, Qiang He. Effect of number of dissected lymph nodes on efficacy of pancreaticoduodenectomy for distal cholangiocarcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 608-612.
[10]	Guangjun Zhong, Chunhua Liu, Wansen Zhu, Xiaolei Xu, Zhaojun Wang. Application of conventional MRI combined with different scanning sequences in preoperative staging diagnosis, chemotherapy efficacy and prognosis evaluation of gastric cancer[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 378-382.
[11]	Baoru Hu, Naijian Shang, Di Gao. DCE-MRI and DWI findings of advanced hepatocellular carcinoma and their correlation with prognosis after immunotherapy[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 399-403.
[12]	Ping Lu, Jian Zou. Value of dynamic changes in coagulation and fibrinolytic markers in evaluating the prognosis of patients with acute pancreatitis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 427-432.
[13]	Yongsheng Li, Jiahe Sun, Shuwei Guo, Yikang Lu, Hongzhou Liu. Short-term postoperative complications and their influencing factors in elderly patients with colorectal cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 962-967.
[14]	Jun Wang, Kunpeng Liu, Lan Yao, Hua Zhang, Yue Wei, Libin Suo, Jun Chen, chengli Miao, Chenghua Luo. Retrospective analysis of anesthesia management of massive transfusion patients undergoing retroperitoneal tumor resection[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 844-849.
[15]	Libin Suo, Kunpeng Liu, Lan Yao, Hua Zhang, Yue Wei, Jun Wang, Jun Chen, Chengli Miao, Chenghua Luo. Key points of anesthesia management and prognostic factors in patients undergoing primary retroperitoneal paraganglioma resection[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 771-776.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export