晚期早产儿健康状况及其影响因素探讨

目的 研究北京市海淀区妇幼保健院1年内,晚期早产儿的出生率、病死率、各系统并发症及早产相关因素等,为进一步建立系统、有效的临床防治方案提供依据.方法 前瞻性统计2007年1月1日至12月31日,北京市海淀区妇幼保健院出生的全部新生儿.胎龄35-37周的晚期早产儿为观察组,生后24 h内检查血、尿、便常规、血气分析、血电解质、监测微最血糖、胸片、头颅B超及心脏彩超;随机选每月1日出生的足月新生儿为对照组,详细记录两组并发症.并对观察组母亲年龄、孕期感染、妊高征、糖尿病、贫血、胎膜早破、羊水异常、脐带异常、胎盘异常、双胎进行分析比较.结果 晚期早产儿333例,出生率为2.71%(333/12 286);并发症以高胆红素血症发生率最高(33.6%),其次为呼吸系统疾病发生率(16.8%)、低血糖(9.0%)、颅内出血(8.1%)、贫血或红细胞增多症(5.7%)、消化系统疾病(5.4%),较足月儿组明显增高(P<0.05);妊高征、贫血、胎膜早破、双胎妊娠是导致晚期早产儿早产的主要高危因素;其病死率为1.20%(4/333),明显高于足月新生儿的0.08%,差异有统计学意义(P<0.05);晚期早产儿住院时间(5.1 d±3.90 d)明显高于足月新生儿(3.2 d±1.61 d)(P<0.05).结论 北京市海淀区妇幼保健院晚期早产儿的出生率为2.71%;其并发症发生率、病死率高于足月新生儿,住院时间也较足月新生儿长;高胆红素血症为最常见并发症;妊高征、贫血、胎膜早破、双胎妊娠是导致晚期早产儿的主要早产因素.儿科医生应重视晚期早产儿,常规收人新生儿科观察治疗.

Health status and affecting factors of late-preterm infants

Objective To study the birth rate,mortality,complications,related factots of preterm infants at Beijing Haidian Maternity and Children's Hospital in 2007,80 as to establish the foundations for a more systematic and effective program for clinical treatments.Methods Data of all the neonates born at Beijing Haidian Maternity and Children's Hospital during the periodfrom January 1,2007 to December 31,2007 were recorded for statistical analysis.All near-term infants of 35-37 weeks of gestational age were taken into observation group.Within 24 hours after birth,blood routine examination,urine and stool routine examination,blood gas analysis and electrolytes,blood glucose monitoring(at 1st,3rd,6th,12th,and 24th hours),chest radiography examination,skull and heart color Doppler ultrasonographic examination were conducted.Full-term infants who were born on the first day of every month were randomly selected as a comparison group(totally 350 cases)for statistical analysis.Complications of the two groups were recorded in detail. Factors such as the ages of parturients,maternal infections,pregnancy-induced hypertension,diabetes,anaemia,premature rupture of membranes,abnormal aminotic fluid,abnormal umbilical cord,abnormal placenta,and twin were analyzed and compared.Results Of the 12 286 infants born during the study period.333 were late-preterm infants;the birth rate of late-preterm infants was 2.71%.Among the complications in late-preterm infants,the hyperbilirubinemia topped at 33.6%.followed by respiratory distress(16.8%),hypoglycemia(9.0%),intracranial hemorrhage(8.1%),anemia or erythrocytosis (5.7%),and digestive system disease(5.4%).Late-preterm infants have higher rate of the hyperbilirubinemia,respiratory distress,hypoglycemia,anemia or erythrocytosis and digestive system disease (P<0.05).The length of hospital stay of late-preterm infants,which is 5.1 d±3.90 d,was significantly longer than those of full-term infants which was 3.2 d±1.61 d(P<0.05).Conclusion The proportion of late-preterm infants was 2.71% of all live born infants at Beijing Haidian Maternity and Children's Hospital from January 1.2007 to December 31,2007.The occurrence rate of complications and mortality rate were higher than those of full-term infants.Late-preterm infants also have longer hospital stay.Hyperbilirubinemia is a coinmon complication for late-preterm infants.Pregnancy-induced hypertension,anerma,premature rupture of membranes and twins are the major causes of higher morbidity and martality of late-preterm infants.Pediatricians should pay much more attention to late-preterm infants,and should accept them tor further observation and treatments.