超未成熟儿和超低出生体重儿早期存活率及影响因素分析

The early survival rate and its influencing factors of extremely premature and extremely low birth weight infants

目的 探讨超未成熟（extremely premature,EP）婴儿和超低出生体重（extremely low birth weight,ELBW）婴儿早期存活率及其影响因素.方法 回顾性分析2010年1月至2015年12月山东大学附属省立医院收治的EP婴儿和（或）ELBW婴儿临床资料.根据其生后存活状况分为存活组和死亡组,比较影响两组婴儿存活率的相关因素;再按出生时间分为2014年前和2014年及以后两组,比较两阶段婴儿存活率和围产期早期死亡的影响因素,并对其死因顺位进行分析.结果 研究期间共纳入EP婴儿和（或）ELBW婴儿142例,其中仅符合EP诊断16例（11.3%）,仅符合ELBW诊断88例（62.0%）,两者均符合38例（26.8%）.中位胎龄28（27,29）周,中位出生体重925（830,965）g.存活组76例（53.5%）,死亡组66例（46.5%）.影响两组婴儿早期存活率的因素为出生体重、胎盘早剥、围产期窒息、早发型脓毒症、肺出血（P均〈0.05）.2014年前共纳入EP婴儿和（或）ELBW婴儿67例,存活30例（44.8%）;2014年及以后共纳入75例,存活46例（61.3%）,两阶段婴儿存活率差异有统计学意义（χ^2=3.900,P=0.048）.2014年前死亡组婴儿围产期死亡原因前2位分别是围产期窒息和早发型脓毒症,2014年及以后死因顺位首位是早发型脓毒症.结论 随着早产儿窒息复苏技术的提高和早产儿呼吸支持策略的优化,EP婴儿和（或）ELBW婴儿早期生存率有所提高,早发型脓毒症成为影响该组人群早期存活率的重要因素.

Objective To study the early survival rate and its influencing factors of extremely preterm infants and extremely low birth weight （ ELBW ） infants.Method All extremely preterm infants and/or ELBW infants in Shandong Provincial Hospital from January , 2010 to December 2015 were studied retrospectively.The factors affecting their survival rate and their complications were analyzed retrospectively . All cases were assigned into the survival group and the death group .On the other hand , they were also assigned into two groups according to their birth , pre-2014 and post-2014.Result A total of 142 extremely preterm infants and/or ELBW infants were enrolled, their gestational age was 28 （27, 29） weeks, birth weight was 925 （830, 965） g.76 cases （53.5%） survived, 66 cases （46.5%） died.Factors associated with the survival rate were early onset sepsis , placental abruption , perinatal asphyxia , birth weight and pulmonary hemorrhage （P〈0.05）.There were 67 cases pre-2014 in which 30 cases survived （44.8%）, while 75 cases post-2014 in which 46 cases survived （ 61.3%） .Comparative analysis between the two groups pre-2014 and post-2014 revealed that the survival rate was significantly different （χ^2 =3.900, P=0.048）.The top 2 underlying causes of death before 2014 were perinatal asphyxia and early onset sepsis . Furthermore, early onset infection became the first cause of death after 2014.Conclusion Along with the prevalence of neonatal resuscitation program and the optimization of respiratory support strategies in premature infants , the early survival rate of extremely preterm infants and /or ELBW infants has improved significantly.However, early onset sepsis may have been the crucial cause for their perinatal mortality .