极不成熟早产儿临床结局分析

Clinical outcomes of extremely premature infants

目的对胎龄低于28周极不成熟早产儿病死率、并发症及其高危因素进行分析与评估,为该类早产儿的临床决策提供参考。方法回顾性分析美国圣路易斯华盛顿大学儿童医院新生儿重症监护室(NICU)2005年1月至2007年8月收治的219例极不成熟早产儿临床资料。结果该组早产儿的病死率为37.7%,导致死亡的独立危险因素为新生儿坏死性小肠结肠炎(NEC)和Ⅲ级以上脑室内出血(IVH)以及母亲患妊娠高血压综合征。存活病例在院需机械通气、鼻塞持续气道正压(NCPAP)、氧疗及住院时间分别为(30.8±38.5)d、(10.5±11.5)d、(84.0±46.7)d和(106.0±78.1)d,其中55.9%出院后需要继续家庭氧疗。呼吸窘迫综合征(RDS)、动脉导管未闭(PDA)、支气管肺发育不良(BPD)、IVH、早产儿视网膜病(ROP)、脑室周围白质软化(PVL)、NEC、院内血流感染(BSI)的发生率分别为85.5%、62.3%、74.2%、36.5%、71.1%、12.6%、12.6%和29.6%。结论极不成熟早产儿无严重并发症时可能存活,但病死率和并发症仍较高,尤其是胎龄不满25周的早产儿,故在对该类极不成熟早产儿实施救治时应进行个体化的综合评估。

Objective To analyze the mortality , morbidity and a variety of perinatal and neonatal factors of extremely premature infants with gestational age of 〈 28 weeks. Methods The clinical charts of 219 infants with gestational age of 〈 28 weeks cared in NICU of St Louise Children＇ s Hospital in USA were reviewed and the data were analyzed retrospectively with SPSS software. Results The mortality was 37.7% and NEC, grade 3 or 4 1VH and PIH were independent risk factors for death. For survivors, the mean length of hospital stay was （ 106.0 ± 78.1 ） days ; the duration of mechanical ventilation, nasal continuous positive airway pressure and oxygen administration, was （30.8 ± 38.5 ）days, （ 10.5 ± 11.5）days and （84.0 ± 46.7）days, respectively. The incidences of RDS, PDA, BPD, IVH, ROP, PVL, NEC and BSI were 85.5%,62.3%,74.2%,36.5%,71.1%, 12.6%, 12.6% and 29.6%, respectively, with 55.9% infants discharging home on oxygen. Conclusion Survival without disability is possible, but the morbidities are still high in extremely premature infant with gestational age of 〈 28 weeks. Individualized discussions and approaches to this group of infants are suggested.