极低和超低出生体重儿生存随访和放弃治疗院内因素分析

A follow-up of the survival and medical factors responsible for the termination of treatment in very or extremely low birth weight infants

目的总结2000～2008年该院新生儿重症监护室(NICU)住院的极低和超低出生体重儿的生存情况,分析放弃治疗的院内因素。方法采用回顾性病例对照研究方法,收集148例患儿的临床资料并随访。通过单因素检验和logistic回归对放弃治疗患儿的危险因素进行分析。结果 148例患儿中,院内死亡20例(13.5%),出院后死亡3例(2.0%),放弃治疗后死亡19例(12.8%),出院后失访30例(20.3%),随访存活病例76例(51.4%)。存活病例中正常47例,先天遗传病2例,不良预后27例。多因素logistic回归分析表明,放弃治疗的院内高危因素主要是新生儿呼吸窘迫综合征(RDS)(P=0.030,OR=11.396,95%CI 1.264～102.701)和住院年限为2004～2006年(P=0.039,OR=9.869,95%CI 1.118～87.140)。结论极低和超低出生体重儿生存情况不容乐观;减少新生儿RDS的发生率可能有利于减少院内放弃治疗病例。

Objective To study the outcomes of very or extremely low birth weight（VLBW/ELBW） infants born between 2000 and 2008 in a single NICU and the medical factors associated with the termination of treatment in some infants. Methods In this case control study,the clinical data of 148 VLBW/ELBW infants were retrospectively studied and the surviving infants were followed up.Both univariate analysis and multivariate logistic regression analysis were used to investigate the medical factors associated with terminating treatment in infants. Results Twenty infants（13.5%） failed to respond to the therapy and died in the hospital.Three infants（2.0%） died after discharge.Nineteen infants（12.8%） did not receive treatment due to decision of the guardian and died.Thirty infants（20.3%） were not followed up after discharge.Seventy-six infants（51.4%） survived,including 47 healthy infants,2 cases of congenital diseases and 27 cases with poor prognosis.Multivariate logistic regression analysis showed there were 2 significant factors associated with terminating treatment： neonatal respiratory distress syndrome（P=0.030,OR=11.396,95%CI 1.264-102.701） and hospitalization periods（the year 2004-2006）（P=0.039,OR=9.869,95%CI 1.118-87.140）. Conclusions The survival status of VLBW and ELBW infants needs to be improved.It is important to decrease the incidence of neonatal respiratory distress syndrome for decreasing the proportion of terminating treatment in the infants.