极低出生体重早产儿143例结局

目的 分析我院近两年内出生体重小于1500 g早产儿的死亡率和并发症.方法 2009-2010年本院共出生12907名活产新生儿,选取出生体重小于1500 g的早产儿,通过登记表获取患儿基本信息,进入电子病历,核对并登记新生儿性别、胎龄、出生体重、住院经过、呼吸支持、吸氧时间、眼底筛查、头颅超声等信息,进行统计学分析.结果 共纳入143例出生体重小于1500 g的早产儿,死亡34例,死亡率23.8%.胎龄和出生体重与死亡率呈负相关(胎龄:r=-0.93,P=0.002;出生体重:r=-0.92,P=0.01).存活的109例婴儿中,中-重度支气管肺发育不良16例,发生率14.7%;早产儿视网膜病38例,发生率34.9%,需要激光治疗11例;脑室内出血(Ⅰ～Ⅲ级)15例,发生率13.8%,存活者中无Ⅳ级脑室内出血者;坏死性小肠结肠炎4例,发生率3.7%.存活者中至少有一种严重并发症(支气管肺发育不良、需要激光治疗的早产儿视网膜病、脑室内出血或坏死性小肠结肠炎)37例,占所有存活婴儿的33.9%.体重低于1000 g者16例,死亡或合并严重并发症15例(93.8%);体重大于1000 g者127例,死亡或合并严重并发症56例(44.1%),两组差异有统计学意义(P<0.05).结论 极低出生体重儿死亡率和严重并发症的发生率较高,提高对并发症的管理有助于改善该类新生儿的生存质量.

Morbidity and mortality outcomes for very low birth weight infants from a single center during 2009-2010

Objective To analyze the neonatal morbidity and mortality outcomes of infants with birth weight below 1500 g. Methods Infants of birth weight below 1500 g were identified through hospital registry from Jan. 2009 to Dec. 2010. Chart review and statistical analysis were performed on gender, gestational age, birth weight, hospitalization course, respiratory support, duration of oxygenation,as well as fundoscope and intracranial ultrasound findings. Results Among the 143 infants with birth weight below 1500 g,34 ( 23. 8% ) infants had died before discharge. Gestational age and birth weight were inversely related to the mortality rate ( gestational age: r =-0. 93,P = 0. 002; birth weight: r =-0. 92,P = 0. 01 ) . Among the 109 survivors,16 patients developed bronchopulmonary dysplasia ( BPD,14. 7% ) ; 38 patients had retinopathy of prematurity ( ROP,34. 9% ) of whom 11 patients ( 10. 1% ) received laser treatment; 4 patients were diagnosed with necrotizing enterocolitis ( NEC,3. 7%) and 15 patients developed grade I-III intraventricular hemorrhage ( IVH,13. 8%) . Totalof 37 survived infants ( 33. 9% of survivals ) with birth weight < 1500 g had at least one severe complication ( BPD,laser treated ROP,IVH or NEC) . In all the patients recruited,56 of the 127 cases had birth weight 1000-1499 g,with combined morbidity and mortality rates of 44. 1% ; 15 of the 16 cases had birth weight < 1000 g,with combined morbidity and mortality rates of 93. 8% ,remarkably higher than that of infants with birth weight between 1000-1499 g ( 44. 1% ) and with statistical difference ( P < 0. 05) . Conclusions Very low birth weight infants have higher morbidity and mortality rate. Optimize the management of severe complications can help to improve the outcome of these infants.