导致极低体重儿宫外死亡和生长发育迟缓的因素分析

Analysis on the causes of extrauterine death and growth retardation of very low birth weight infants

目的探讨极低体重儿围生期死亡和生长缓慢的原因。方法回顾性分析296例极低体重儿的临床资料、患儿围生期死亡情况以及可能导致患儿死亡的主要原因和患儿宫外生长情况及可能的生长发育迟缓的原因。结果 296例极低体重儿围生期死亡91例,占30.74%;单因素方差分析显示产妇合并妊娠期高血压疾病、脐带绕颈、胎龄低、胎重小及出生后颅内出血、感染是导致极低体重儿死亡的主要原因,Logistic分析显示产妇合并妊娠期高血压疾病、脐带绕颈和颅内感染是极低体重儿死亡的独立危险因素。患儿成功出院205例,其中94例生长发育迟缓,占45.86%;单因素方差分析显示母亲妊娠期高血压疾病、呼吸暂停、坏死性小肠结肠炎和静脉营养支持是导致极低体重儿出院后生长缓慢的主要原因,Logistic分析显示母亲妊娠期高血压疾病是导致极低体重儿出院后生长缓慢的独立危险因素。结论对于极低体重新生儿,产妇合并妊娠期高血压疾病、脐带绕颈和颅内感染是导致死亡的独立危险因素,母亲妊娠期高血压疾病是导致宫外生长发育迟缓的独立危险因素。应根据具体情况加以重视和护理,则有可能降低极低体重儿死亡和生长缓慢。

Objective To explore the causes of perinatal death and growth retardation of very low birth weight infants. Methods The clinical data, perinatal death, main causes of perinatal death, extrauterine growth, and probable causes of growth retardation of 296 very low birth weight infants were analyzed retrospectively. Results Among 296 very low birth weight infants, perinatal death occurred in 91 infants, accounting for 30. 74% ; univariate analysis showed that the main causes of very low birth weight infants included hypertensive disorder com- plicating pregnancy （ HDCP）, umbilical cord around the neck, low gestational age, low fetal weight, intracranial hemorrhage after birth, and infection. Logistic analysis showed that HDCP, umbilical cord around the neck, and intracranial infection were independent risk factors of perinatal death. Two hundred and five infants successfully discharged, including 94 infants with growth retardation, accounting for 45.86% ; univariate analysis showed that HDCP, apnea, necrotizing enterocolitis, and parenteral nutrition support are main causes of growth retardation of very low birth weight infants after leaving the hospital ; logistic analysis showed that HDCP was the independent risk factor of growth retar- dation of very low birth weight infants after leaving the hospital. Conclusion HDCP, umbilical cord around the neck, and intracranial in- fection are independent risk factors of perinatal death, HDCP is the independent risk factor of growth retardation of very low birth weight in- fants after leaving the hospital. According to the specific circumstances, the infants should be paid more attention to, nursing should be enhanced, then death and growth retardation of very low birth weight infants might be decreased.