危重新生儿会诊抢救单中心10年690例极低和超低出生体质量儿临床救治分析

目的 探讨上海市危重新生儿会诊抢救单中心超低（<1 000 g）和极低（<1 500 g）出生体质量儿的救治、临床转归及并发症变迁情况。方法 选取2008年1月至2017年12月于上海交通大学附属儿童医院新生儿科住院治疗、出生体质量<1 500 g的新生儿，对其临床资料进行回顾性分析。结果 共纳入出生体质量<1 500 g的新生儿690例，其中存活502例（72.8%），死亡96例（13.9%），自动出院92例（13.3%）。近5年（2013-2017年）出生体质量<1 000 g的早产儿存活率较前5年（2008-2012年）下降[45.2%（33/73）vs 64.7%（11/17），P<0.05]。低体温是超低、极低新生儿中发生率最高的并发症，近5年与前5年相比其发生率差异无统计学意义[81.0%（363/448）vs 82.6%（200/242），P>0.05]；新生儿呼吸窘迫综合征[70.1%（314/448）vs 26.9%（65/242），P<0.01]、支气管肺发育不良[19.4%（87/448）vs 9.5%（23/242），P<0.01]、新生儿坏死性小肠结肠炎[16.3%（73/448）vs 6.2%（15/242），P<0.01]和感染[50.4%（226/448）vs 29.8%（72/242），P<0.01]的发生率近5年较前5年有所增加，而窒息[36.6%（164/448）vs 41.7%（101/242），P<0.01]、早产儿视网膜病[1.3%（6/448）vs 5.0%（12/242），P<0.01]、低血糖[11.2%（50/448）vs 17.8%（43/242），P<0.05]的发生率较前下降。结论 出生体质量<1 500 g的早产儿存活率仍较低，窒息、感染等仍是威胁早产儿存活的重要因素，亟需进一步加强产科与新生儿科的协作以改善早产儿预后。

Clinical rescue of 690 neonates with extremely low birth weight and very low birth weight in the latest 10 years: experience from a single center

Objective To explore the clinical rescue, clinical outcomes and complications in neonates with extremely low birth weight (ELBW, <1 000 g) and very low birth weight (VLBW, <1 500 g) in a single center in Shanghai. Methods Clinical data of neonates with birth weight less than 1 500 g admitted to Shanghai Children''s Hospital between Jan. 2008 and Dec. 2017 were retrospectively analyzed. Results A total of 690 neonates were enrolled in this study. The overall survival rate was 72.7% (502/690) and in-hospital mortality rate was 13.9% (96/690). There was 13.3% (92/690) discharge against medical advice and the outcome was uncertain. The survival rate of VLBW neonates in 2013-2017 was significantly lower than that in 2008-2012 (45.2%[33/73] vs 64.7%[11/17], P<0.05). The most common complication was hypothermia, but there was no significant difference in the incidence of hypothermia between the latest 5 years and the first 5 years (81.0%[363/448] vs 82.6%[200/242], P>0.05). In 2013-2017, there was a significant increase in the occurrence of neonatal respiratory distress syndrome (NRDS) (70.1%[314/448] vs 26.9%[65/242], P<0.01), bronchopulmonary dysplasia (BPD) (19.4%[87/448] vs 9.5%[23/242], P<0.01), necrotizing enterocolitis (NEC) (16.3%[73/448] vs 6.2%[15/242], P<0.01) and infection (50.4%[226/448] vs 29.8%[72/242], P<0.01), while asphyxia (36.6%[164/448] vs 41.7%[101/242], P<0.01), retinopathy of prematurity (ROP) (1.3%[6/448] vs 5.0%[12/242], P<0.01) and hypoglycemia (11.2%[50/448] vs 17.8%[43/242], P<0.05) were decreased as compared with those in 2008-2012. Conclusion The overall survival rate is still low in neonates with ELBW and VLBW. Asphyxia and infection are still poorly controlled. The cooperation between institutions of obstetrics and neonatalogy is needed to improve the outcome of neonates with ELBW and VLBW.