超低出生体重儿105例临床分析

Clinical analysis of 105 extremely low birth weight infants

目的 分析超低出生体重 （ELBW） 儿的临床资料,了解其患病率和预后.方法对2007年1月至2011年12月生后24 h内收入复旦大学附属儿科医院的ELBW患儿的临床资料进行性回顾性分析.收集并分析患儿一般情况、围产期资料、疾病诊断、治疗和预后等临床资料.结果 共收入105例ELBW患儿,其中男54例、女51例,出生胎龄（28.4±2.6）周,出生体重（860±121）g.最常见的合并症是新生儿呼吸窘迫综合征89例（84.8%）,然后是呼吸暂停58例（55.2%）、败血症47例（44.8%）和动脉导管开放46例（43.8%）.好转出院51例（48.6%）,平均住院天数（97±29）d,出院时存在宫外生长迟缓患儿高达90.2%（46/51）.住院期间因疾病死亡17例,除去社会因素外,败血症（7例）依旧是主要死因.胎龄〈34周的ELBW患儿中产前激素使用率仅为40.8%（42/103）.结论 ELBW儿住院病例数增加明显,产前激素的推广使用、无创式辅助通气的应用、感染预防、积极的营养支持治疗对于提高ELBW的存活率、减少患病率和改善预后至关重要.

Objective To explore the changes of outcome and morbidity in extremely low birth weight （ELBW） infants. Methods A retrospective study was performed for ELBW infants admitted into Children＇s Hospital,Fudan University within 24 hours after birth from January 2007 to December 2011. The maternal and neonatal data were collected by reviewing the medical charts and entered into the dataset. Results A total of 105 ELBW infants （54 males, 51 females ） were enrolled. The average gestational age was （28.4 ± 2. 6 ）weeks and birth weight was （860 ± 121 ）g. Neonatal respiratory syndrome （NRDS） （ n = 89, 84. 8% ） , apnea （ n = 58,55.2% ） , sepsis （ n = 47,44. 8% ） and patent duetus arteriosus （n = 46,43.8% ） remained their major complications. Sepsis was the commonest cause of mortality （7/17） excluding social factors. The incidence of extrauterine growth restriction （46/51,90. 2% ） was significantly high at discharge. And the use of antenatal steroids was merely 40. 8% （ 42/103 ） in ELBW infants at a gestation age under 34 weeks. Conclusions The number of ELBW infants has increased dramatically. Antenatal steroids, noninvasive respiratory support, prevention of infections and optimal nutrition supports arc key factors of improving the survival rate, short and long-term outcomes of ELBW infants.