新生儿重症监护病房早产儿脑损伤危险因素分析

Risk factors of brain damage in preterm infants hospitalized in neonatal intensive care unit

目的调查新生儿重症监护病房（NICU）早产儿脑损伤的发生情况并分析其高危因素。方法将2006年2月1日至2007年1月31日人住复旦大学附属儿科医院NICu的胎龄≤34周或出生体重≤2000g的早产儿纳入研究。应用超声诊断仪对早产儿进行系列床边头颅B超检查。同时收集临床资料，分析早产儿脑损伤的发生率，用Logistic回归模型分析其危险因素。结果（1）328例早产儿完成系列头颅B超检查，141例（43．0％）发生脑室内出血（IVH），其中轻度101例，重度40例。9．8％的患儿（32／328）发生脑白质损伤（WMD）。13．4％的患儿（44／328）发生持续脑室扩大。10．7％的患儿（35／328）在生后初次头颅B超筛查时即发现有颅内囊肿形成。（2）IVH组和WMD组患儿的出生体重和胎龄较未发病组低，差异有统计学意义（P〈0．05）。（3）Logistic回归分析提示出生体重、感染、小于胎龄儿、机械通气是IVH的独立危险因素。出生体重是wMD的独立危险因素。结论NICU早产儿脑损伤发生率较高。出生体重、感染、小于胎龄儿、机械通气是IVH的独立危险因素。出生体重是WMD的独立危险因素。

Objective To investigate the incidence and the risk factors of preterm infants with brain damage in neonatal intensive care unit （NICU）. Methods Premature infants ≤ 34 weeks of gestation or ≤ 2000 g of birth weight, admitted to NICU of the Children＇s Hospital of Fudan University from February 2006 to January 2007, were included in this study. Transcranial ultrasound was performed serially. Clinical data of the patients were analyzed to determine the incidence and the risk factors of brain damage. Results Totally 328 preterm infants achieved serial transcranial ultrasound scan. IVH occured in 141 cases （43.0%）, among which, 101 infants had mild IVH, and 40 had severe IVH. Thirty two （9.8%） preterm infants had white matter damage （WMD）, 44 （13.4%） had persistent ventricular enlargement and 35 （10.7%） had intracranial cystic lesions at the first transcranial ultrasound scan. The average birth weight and gestational age for preterm infants with IVH or WMD were significantly lower than those without （P〈0.05）. Birth weight, neonatal infection, small for gestational age, mechanical ventilation were independent risk factors of IVH, and birth weight was the only independent risk factor of WMD. Conclusions The incidence of brain damage in preterm infants remains relatively high in NICU. Birth weight, neonatal infection, small for gestational age, mechanical ventilation are independent risk factors of IVH. Birth weight is the independent risk factor of WMD.