2008—2017年超低出生体重早产儿临床救治分析  

Analysis of clinical characteristics of extremely low birth weight premature infants during 2008-2017

作　　者：冯周善 吴繁[1] 陈耀勇[1] 崔其亮[1] 贾春宏 Feng Zhoushan;Wu Fan;Chen Yaoyong;Cui Qiliang;Jia Chunhong(Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院儿科,510150

出　　处：《中华新生儿科杂志（中英文）》2019年第4期269-274,共6页Chinese Journal of Neonatology

基　　金：广州市科技与信息化局资助项目(2O14Y2-OOO53).

摘　　要：目的探讨超低出生体重(extremely low birth weight,ELBW)早产儿的临床救治现状、存活率、并发症发生率及影响ELBW早产儿死亡的危险因素。方法选取广州医科大学附属第三医院新生儿科2008年1月至2017年12月收治出院的ELBW早产儿临床资料,回顾性分析不同年份、不同出生体重ELBW早产儿存活率和并发症发生率,应用多因素非条件Logistic回归分析影响ELBW早产儿死亡的危险因素。结果(1)研究期间共收治新生儿16 948例,早产儿8 910例,其中ELBW早产儿438例,占同期新生儿的2.6%(438/16 948)、早产儿的4.9%(438/8 910)。排除资料不全和失访3例后最终纳入435例。胎龄(28.0±2.1)周,出生体重900(750,950)g。剔除放弃治疗179例,存活率为81.6%(209/256)。(2)随时间推移,ELBW早产儿在同年新生儿和早产儿中的构成比均呈上升趋势(χ^2趋势值=6.818、27.850,P=0.009、P<0.001)。(3)前后5年ELBW早产儿存活率相比差异无统计学意义(P>0.05);不同出生体重组存活率随出生体重增加呈上升趋势,出生体重<700 g早产儿存活率为40.0%(6/15),出生体重900~999 g达88.5%(139/157)(χ2趋势值=32.648、P<0.001)。(4)ELBW早产儿并发症发生率(诊断例数/评估例数)前3位依次为新生儿呼吸窘迫综合征(87.5%,224/256)、早产儿视网膜病(63.1%,123/195)、支气管肺发育不良(63.0%,126/200)。(5)多因素非条件Logistic回归分析显示,出生体重<900 g(<700 g:OR=10.147,95%CI 2.684~38.360;700~799 g:OR=6.978,95%CI 1.647~29.555;800~899 g:OR=4.727,95%CI 1.060~21.082)、出生胎龄<28周(OR=3.529,95%CI 1.601~7.778)是影响ELBW早产儿死亡的危险因素(P<0.05);产前使用糖皮质激素(OR=0.155,95%CI 0.069~0.353)是保护性因素(P<0.001)。结论随着ELBW早产儿救治数逐年增加,ELBW早产儿存活率与出生体重成正相关;产前使用糖皮质激素有利于提高ELBW早产儿存活率。Objective To study the survival rate, complications and risk factors affecting clinical outcomes in extremely low birth weight (ELBW) premature infants. Method From January 2008 to December 2017, clinical data of ELBW infants admitted to the department of neonatology of our hospital were collected. The survival rates and the incidences of complications were compared between different subgroups of different birth weight (BW) and discharging date. The risk factors affecting the survival rate of ELBW infants were analysed using multivariate unconditional Logistic regression analysis. Result (1) A total of 438 ELBW infants were enrolled, representing 4.9%(438/8 910) of all discharged preterm infants, and 2.6%(438/16 948) of all discharged neonates during the study period. Among them, 3 were excluded because of incomplete data and lost of follow-up. The BW was 900 (750,950) g and the gestational age was (28.0±2.1) weeks. The overall survival rate was 81.6%(209/256) with 179 cases excluded for giving up treatment.(2) From 2008 to 2017, the percentages of ELBW infants among all discharged newborns and all discharged premature infants increased annually (χ^2 trend=6.818, 27.850, P=0.009,<0.001).(3) No significant differences existed in the survival rates of ELBW infants between 2013-2017 and 2008-2012 (P>0.05). The survival rates of different BW groups (<700 g, 700~799 g, 800~899 g, and 900~999 g) increased from 40.0%(6/15) to 88.5%(139/157)(χ^2 trend=32.648, P<0.001).(4) The main complications in ELBW infants were respiratory distress syndrome 87.5%(224/256), retinopathy of prematurity 63.1%(123/195), and bronchopulmonary dysplasia 63.0%(126/200).(5) Multivariate unconditional logistic regression analysis showed that BW<900 g (<700 g: OR=10.147, 95%CI 2.684~38.360;700~799 g: OR=6.978, 95%CI 1.647~29.555;800~899 g: OR=4.727, 95%CI 1.060~21.082, P<0.05), and gestational age<28 weeks (OR=3.529, 95%CI 1.601~7.778, P=0.002) were the risk factors for survival rate and antenatal steroids was the protective factor (OR=0.155,

关 键 词：婴儿 超低出生体重 存活率 危险因素 婴儿 早产 

分 类 号：R722[医药卫生—儿科]