中国14家医院超/极早产儿早期预后的多中心调查  

Mortality and morbidity outcomes of preterm infants from the 14 neonatal care centers in China

作　　者：孔祥永 张珊[1,3] 封志纯 徐凤丹 童笑梅[5] 刘少君 刘子源[5] 吕红艳[6] 杨李红[6] 吴素静[6] 巨容[7] 汪瑾[7] 彭立[7] 赵小林 郭金珍 李占魁 曾淑娟 丘惠娴 温伟溪 武辉[10] 李莹[10] 李楠 贾文峥[11] 张雪峰[11] 郭果 刘卫鹏[12] 王凤[12] 李改梅 刘芳[13] 李薇[13] 赵晓英[13] 程红斌[14] 许云波[14] 陈文超[14] 尹欢[14] 丁艳洁[15] 王晓亮[15] 单瑞艳[15] 许平[16] 韩梅盈[16] 杨春燕[16] 陈铁强[17] 张路 叶春华[17] KONG Xiang-yong;ZHANG Shan;FENG Zhi-chun;XU Feng-dan;TONG Xiao-mei;LIU Shao-jun;LIU Zi-yuan;LVHong-yan;YANG Li-hong;WU Su-jing;JU Rong;WANG Jin;PENG Li;ZHAO Xiao-lin;GUO Jin-zhen;LI Zhan-kui;ZENGShu-juan;QIU Hui-xian;WEN Wei-xi;WU Hui;LI Ying;LI Nan;JIA Wen-zheng;ZHANG Xue-feng;GUO Guo;LIU Weipeng;WANG Feng;LI Gai-mei;LIU Fang;LI Wei;ZHAO Xiao-ying;CHENG Hong-bin;XU Yun-bo;CHEN Wen-chao;YIN Huan;DING Yan-jie1;WANG Xiao-liang1;SHAN Rui-yan1;XU Ping1;HAN Mei-ying;YANG Chun-yan1;CHEN Tieqiang1;ZHANG Lu1;YE Chun-hua(Beijing Key Laboratory of Children Organ Failure,Department of Neonatology,Bayi Children'sHospital,PLA Army General Hospital,Beijing 100700,China;Department of Pediatrics,the First Hospital of JilinUniversity,Jilin Changchun 130021,China;Department of Neonatology,302Hospital of PLA,Beijing 100039,China;Departmentof Pediatrics,Navy General Hospital,Beijing 100048,China;Department of Neonatology,Bethune International Peace Hospital,HebeiShijiazhuang 050000,China;Department of Pediatrics,Huangshi Women's and Children's Hospital,Hubei Huangshi 435003,China;Department of Pediatrics,Yantai Yuhuangding Hospital,Shandong Yantai 264000,China;Department of Pediatrics,LiaochengPeople's Hospital,Shandong Liaocheng 252004,China;Department of Neonatology,Changsha Hospital for Maternal and ChildHealth Care,Hunan Changsha 410007,China;Clinical Medical College,PLA Army General Hospital,Southern MedicalUniversity,Beijing 100700,China;National Engineering Laboratory,Key Technology for the Prevention and Control of Birth Defects,Beijing 100000,China;Guangdong Medical College,Guangdong Dongguan 523808,China;Department of Neonatology,the ThirdHospital of Beijing University,Beijing 100191,China;Department of Neonatology,Handan Women's and Children's Hospital,HebeiHandan 056001,China;Department of Neonatology,Chengdu Women's and Children's Central Hospital,Sichuan Chengdu 610091,China;Department of Neonatology,Xibei Women's and Children's Hospital,Shaanxi Xi'an 710003,China;Department of Pediatrics,Longgang Central Hospital of S

机构地区：[1]儿童器官功能衰竭北京市重点实验室,陆军总医院附属八一儿童医院新生儿科,北京100700 [2]南方医科大学陆军总医院临床医学院,北京100700 [3]出生缺陷防控关键技术国家工程实验室,北京100000 [4]广东医学院,广东东莞523808 [5]北京大学第三医院新生儿科,北京100191 [6]邯郸市妇幼保健院新生儿科,河北邯郸056001 [7]成都市妇女儿童中心医院新生儿科,四川成都610091 [8]西北妇女儿童医院新生儿科,陕西西安710003 [9]深圳市龙岗中心医院儿科,广东深圳518116 [10]吉林大学第一医院儿科,吉林长春130021 [11]解放军第302医院新生儿科,北京100039 [12]海军总医院儿科,北京100048 [13]白求恩国际和平医院儿科,河北石家庄050000 [14]黄石市妇幼保健院儿科,湖北黄石435003 [15]烟台毓璜顶医院儿科,山东烟台264000 [16]聊城市人民医院儿科,山东聊城252004 [17]长沙妇幼保健院新生儿科,湖南长沙410007

出　　处：《中国医刊》2018年第12期1356-1362,共7页Chinese Journal of Medicine

摘　　要：目的报道国内14家医院产科收治的出生胎龄24～31周早产儿的早期病死率和主要并发症发生率,并分析其影响因素。方法收集2013年1月1日至2014年12月31日国内14家医院产科收治的出生胎龄24～31周早产儿的一般资料,分析各胎龄组早产儿的病死率和主要并发症如支气管肺发育不良(bronchopulmonary dysplasia,BPD)、新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、早产儿视网膜病(retinopathy of prematurity,ROP)、脑室内出血(intraventricular hemorrhage,IVH)和败血症等的发生率,并分析其影响因素。结果 24～31周各胎龄组早产儿的存活率分别为0、28.0%、84.8%、83.5%、87.4%、90.7%、93.9%和96.0%,无严重合并症存活率分别为0、8.0%、60.6%、53.2%、62.3%、67.9%、79.1%和85.8%,随着胎龄的增加存活率及无严重合并症存活率均增加。胎龄<28周早产儿的产前激素使用率低于28～31周(28.0%～44.3%vs 49.7%～59.6%,P<0.05),总体使用率为56.0%,足疗程为32.3%。早产儿胎龄越小,并发症发生率越高。24～31周早产儿总体呼吸窘迫综合征的发生率为58.5%, BPD的发生率为12.5%,NEC的发生率为3.9%,IVH的发生率为15.4%,ROP的发生率为5.4%,动脉导管未闭的发生率为28.4%,败血症的发生率为9.7%。低胎龄(OR=0.891,95%CI:0.796～0.999,P=0.0047)、低出生体重(OR=0.520,95%CI:0.420～0.643,P=0.000)、小于胎龄儿(OR=1.861,95%CI:1.148～3.017,P=0.012)和5分钟低Apgar评分(OR=1.947,95%CI:1.269～2.987,P=0.002)是早产儿死亡的高危因素。低胎龄(OR=0.666,95%CI:0.645～0.688,P=0.000)、低出生体重(OR=0.921,95%CI:0.851～0.997,P=0.041)、男性(OR=1.235,95%CI:1.132～1.347,P=0.000)、小于胎龄儿(OR=1.511,95%CI:1.300～1.755,P=0.000)、5分钟时低Apgar评分(OR=2.262,95%CI:1.950～2.624,P=0.000)以及围产期合并症如前置胎盘(OR=1.452,95%CI:1.202～1.753,P=0.000)、胎盘早剥(OR=1.380,95%CI:1.082～1.760,P=0.010)、妊娠期高血压疾病(OR=2.262,95%CI:1.950～2.624,P=0.00Objective To describe the survival and morbidity rates of extreme to very preterm infants in 14 neonatal-intensive care hospitalsin China. Method Data were collected from January 1, 2013 to December 31, 2014 for preterm neonates with gestational age (GA) between24 to 31 complete weeks born in hospitals from our collaborative study group. The primary outcomes were survival and major morbiditiesprior to hospital discharge. Major morbidities included bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizingenterocolitis (NEC), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis. Mutivariate logistic regression wasused to analyze the risk factor influencing on the outcomes.Result The survival rate prior to discharge was increased with increasing GA(0, 24 weeks; 28.0%, 25 weeks; 84.8%, 26 weeks; 83.5%, 27 weeks; 87.4%, 28 weeks;90.7%, 29 weeks; 93.9%, 30 weeks; 96.0%, 31weeks). Rate of survival and without severe morbidity according to GA were 0 at 24 weeks, 8.0% at 25 weeks, 60.6% at 26 weeks; 53.2%at 27 weeks; 62.3% at 28 weeks; 67.9% at 29 weeks; 79.1% at 30 weeks, 85.8% at 31 weeks respectively. Rate of antenatal steroid usewas 56.0%. The antenatal steroid use was lower in GA<28 weeks infants than that in GA between 28-31 weeks (28%-44.3% vs 49.7%-59.6%, P<0.05). Infants at the lowest GA had a highest incidence of morbidities. Overall, 58.5% had respiratory distress syndrome,12.5% bronchopulmonary dysplasia, 3.9% necrotizing enterocolitis, 15.4% intraventricular hemorrhage, 5.4% retinopathy of prematurity,28.4% patent ductus arteriosus, and 9.7% sepsis. Mortality and morbidity were influenced by gestational age (OR=0.891, 95%CI: 0.796-0.999, P=0.0047 and OR=0.666, 95%CI: 0.645-0.688, P=0.000, respectively), birth weight (OR=0.520,95%CI:0.420-0.643, P=0.000and OR=0.921, 95%CI:0.851-0.997, P=0.041, respectively), SGA (OR=1.861, 95%CI: 1.148-3.017, P=0.012 and OR=1.511, 95%CI:1.300-1.755, P=0.000, respectively), Apgar score<7 at 5 min (OR=1.947, 95%CI: 1.269-2.987, P=0.0

关 键 词：超早产儿 极早产儿 预后 

分 类 号：R722[医药卫生—儿科]