极低、超低出生体重儿存活情况及住院并发症分析-现代医学

极低、超低出生体重儿存活情况及住院并发症分析

单位：徐州医科大学附属医院新生儿科, 江苏徐州 221000

分类号：R720.597

出版年·卷·期（页码）：2020·48·第一期（82-87）

摘要：

目的： 分析极低出生体重儿（very low birth weight infants，VLBWI）和超低出生体重儿（extremely low birth weight infants，ELBWI）早期生存状况，为提高存活率，降低病死率及并发症发生率，改善预后提供依据与借鉴。方法： 回顾性分析2015年1月至2017年12月本院收治的VLBWI及ELBWI的临床资料，根据入院时间、胎龄、出生体重等分别分组，用χ²检验对其临床资料进行统计学分析，并对影响转归的相关因素进行Logistic回归分析。方法： 共纳入患儿319例，其中VLBWI 280例，ELBWI 39例，存活277例，死亡42例，总体存活率86.8%。VLBWI总体存活率91.4%，ELBWI总体存活率53.8%。放弃治疗或自动出院比例为26.6%。21例新生儿救治无效死亡，大多于出生后24 h至1周内死亡，死亡主要原因为肺出血、新生儿感染及新生儿呼吸窘迫综合征；胎龄、出生体重为死亡的保护性因素，感染、肺出血是其危险因素。2015-2017年VLBWI、ELBWI存活率逐年上升，且随胎龄、出生体重的增加，存活率上升，差异均有统计学意义（P < 0.05）。发病率较高的并发症为新生儿呼吸窘迫综合征、新生儿高胆红素血症、早产儿贫血、院内获得性感染等。新生儿呼吸窘迫综合征随胎龄、出生体重增加发生率降低，支气管肺发育不良随胎龄增加发生率降低，肺出血随出生体重增加发生率降低，差异均有统计学意义（P < 0.05）。方法： VLBWI、ELBWI存活率呈逐年递增趋势，随胎龄及出生体重增加，存活率上升，死亡率、部分并发症发生率降低；死亡主要原因为肺出血、新生儿感染及新生儿呼吸窘迫综合征，大多于出生后24 h至1周内死亡，胎龄、出生体重为死亡的保护性因素，感染、肺出血是其危险因素；加强对VLBWI、ELBWI相关住院并发症的防治，提高存活率，改善生存质量。

Objective: To analyze the early survival status of very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI), and provide evidence and reference for improving survival rate, reducing mortality and complications, and improving prognosis. Methods: The clinical data of VLBWI and ELBWI admitted to our hospital from January 2015 to December 2017 were retrospectively analyzed. The time of admission, gestational age, birth weight, etc. were grouped, the clinical data were statistically analyzed by χ² test.,and relevant factors affecting outcome were analyzed by Logistic regression. Results: A total of 319 cases were enrolled, including 280 patients with VLBWI, 39 patients with ELBWI, among whom 277 patients survived, and 42 patients died. The overall survival rate was 86.8% and the mortality rate was 13.2%. The overall survival rate of VLBWI was 91.4%, and the overall survival rate of ELBWI was 53.8%. The proportion of abandoning treatment or voluntary discharge was 26.6%. 21 neonates died due to ineffective treatment. The time of death was mainly from 24 hours to 1 week after birth. The main causes of death were pulmonary hemorrhage, neonatal infection and neonatal respiratory distress syndrome. Gestational age and birth weight were protective factors for death, and infection and pulmonary hemorrhage were risk factors. From 2015 to 2017, the survival rate increased year by year. And along with the increased gestational age and birth weight, the survival rate increased, too. The difference was statistically significant (P < 0.05).The higher incidence of complications were neonatal respiratory distress syndrome (61.1%), neonatal hyperbilirubinemia (40.1%), premature infant anemia (32.3%), hospital acquired infection (25.7%) and so on. Neonatal respiratory distress syndrome decreased along with the increase of gestational age and birth weight. The incidence of bronchopulmonary dysplasia decreased with gestational age, and the incidence of pulmonary hemorrhage decreased with birth weight. The difference was statistically significant (P < 0.05). Conclusion: The survival rate of VLBWI and ELBWI increases year by year. With the increase of gestational age and birth weight, the survival rate increases, the mortality rate and partial complication rate decrease. The main causes of death are pulmonary hemorrhage, neonatal infection and neonatal respiratory distress syndrome, due to which death occurs 24 h to 1 week after birth. The gestational age and birth weight were the protective factors of death. Infection and pulmonary hemorrhage were risk factors. The prevention and treatment of VLBWI and ELBWI related hospital complications were improved, the survival rate was improved, and the quality of life was improved.

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