摘要
【目的】分析影响重症监护病房新生儿听力筛查未通过的危险因素,在此基础上构建列线图模型并加以评估。【方法】调查分析本院分娩并收入重症监护病房治疗的新生儿1650例进行听力筛查,收集资料,以多因素Logistic回归分析新生儿听力筛查未通过的危险因素,以R软件构建列线图模型,并使用ROC曲线下面积及H-L拟合度验证模型。【结果】本研究共调查1650例(3300耳)新生儿,筛查未通过者占335例(20.30%),其中左耳占78例(4.73%),右耳占85例(5.15%),双耳均未通过者172例,占10.42%;对本研究纳入1650例重症监护病房新生儿进行单因素分析,结果显示,出生体重≤1500 g、胎龄≤32周、NBNA评分≤37分、胆红素脑病、达到换血标准的高胆红素血症、巨细胞病毒引起的宫内感染、永久性听力损伤家族史或颅面部畸形均为影响新生儿听力筛查未通过的危险因素(P<0.05);进一步行多因素Logistic回归分析,颅面部畸形、胆红素脑病、NBNA评分、出生体重≤1500 g、达到换血标准的高胆红素血症、胎龄≤32周为影响重症监护病房新生儿听力筛查未通过的独立危险因素(P<0.05);使用R软件构建影响重症监护病房新生儿听力筛查未通过的列线图预测模型,以H-L拟合度检验及ROC曲线下面积评估模型的偏差水平及区分度,其中H-L拟合度检验结果为χ^(2)=2.576(P=0.311),表明模型准确度良好,ROC曲线下面积为0.883(灵敏度、特异度分别为84.0、83.9),表明模型区分度较好。【结论】颅面部畸形、胆红素脑病、NBNA评分、出生体重≤1500 g、达到换血标准的高胆红素血症、胎龄≤32周为影响重症监护病房新生儿听力筛查未通过的独立危险因素,以此建立的列线图模型准确度及区分度较好,能够用于甄别高风险人群,以及时为临床提供治疗及干预。
【Objective】To analyze the risk factors that affect neonatal hearing screening failure in intensive care unit,and to build a nomogram model on this basis and evaluate it.【Methods】A total of 1650 neonates delivered in our hospital and admitted to the intensive care unit were investigated and analyzed for hearing screening.The data were collected and the risk factors of neonatal hearing screening failure by multivariate Logistic regression were analyzed,the nomogram model was constructed with R software,and the area under the ROC curve and H-L fit were used to verify the model.【Results】A total of 1,650 neonates(3300 ears)were investigated in this study,among them,335 cases(20.30%)failed the screening,of which 78 cases(4.73%)were in the left ear,85 cases(5.15%)were in the right ear,and 172 cases(10.42%)were in both ears;a univariate analysis of 1650 neonates in the intensive care unit included in this study showed that birth weight≤1500g,gestational age≤32 weeks,NBNA score≤37,bilirubin encephalopathy,and hyperbilirubinemia that met the transfusion standards,intrauterine infection caused by cytomegalovirus,family history of permanent hearing loss,or craniofacial malformation were all risk factors that affected neonatal hearing screening failure(P<0.05);further multivariate logistic regression analysis showed that craniofacial malformation,bilirubin encephalopathy,NBNA score,birth weight≤1500 g,hyperbilirubinemia that met the transfusion standards,and gestational age≤32 weeks were independent risk factors that affected neonatal hearing screening failure in the intensive care unit(P<0.05);R software was used to construct a nomogram prediction model that affected neonatal hearing screening failure in the intensive care unit,and the deviation level and discrimination of the model were evaluated with H-L fit test and the area under the ROC curve,the H-L fit test result was χ^(2)=2.576(P=0.311),indicating that the model had good accuracy,the area under the ROC curve was 0.883(sensitivity and specifici
作者
史洁丽
刘桂芬
倪岫云
王娟
SHI Jia-li;LIU Gui-fen;NI Xiu-yun;WANG Juan(Department of Neonatology,Songjiang Maternal and Child Health Hospital,Shanghai 201600,China)
出处
《武警后勤学院学报（医学版）》
CAS
2021年第9期1-4,9,共5页
Journal of Logistics University of PAP（Medical Sciences）
关键词
新生儿听力筛查
列线图模型
评估
验证
neonatal hearing screening
nomogram model
evaluation
verification
