不同受孕方式超低和极低出生体重儿临床特点分析

Clinical characteristics of extremely and very low birth weight infants conceived with different methods of fertilization

目的 探讨辅助生殖技术（assisted reproductive technology,ART）受孕与自然受孕（spontaneously conceived,SC）出生的超低和极低出生体重儿临床特点.方法 选取2014年7月至2016年7月本院新生儿重症监护病房收治的出生体重〈1500 g早产儿.根据母亲受孕方式分为ART组和SC组.比较两组早产儿基本情况、相关并发症、呼吸支持、住院时间、住院费用及死亡率等.结果 共纳入超低和极低出生体重儿527例,胎龄（30.6±2.0）周;出生体重（1198±202）g;其中超低出生体重儿88例,极低出生体重儿439例;小于胎龄儿156例,适于胎龄儿371例;ART组81例,SC组446例.ART组胎龄小于SC组,双/多胎比例高于SC组,住院时间和住院费用多于SC组,呼吸衰竭、支气管肺发育不良、败血症、真菌感染、心力衰竭、弥散性血管内凝血、多器官功能障碍综合征发生率高于SC组（48.1%比34.8%、50.6%比16.1%、19.8%比7.0%、8.6%比2.9%、39.5%比17.7%、22.2%比7.2%、29.6%比15.0%）,高胆红素血症发生率低于SC组（81.5%比90.8%）,差异均有统计学意义（P〈0.05）.两组呼吸支持情况及死亡率差异无统计学意义（P〉0.05）.结论与SC相比,ART受孕的超低和极低出生体重儿死亡风险并未增加,但具有胎龄小、双/多胎比例和并发症发生率增高、住院时间延长和住院费用增加的潜在风险,围产期保健及管理时应高度关注.

Objective To study the differences of clinical characteristics of extremely and very low birth weight （ E/VLBW） infants conceived with assisted reproductive technology （ ART） and spontaneous conception （ SC） .Method From July 2014 to July 2016, preterm infants with birth weight less than 1500 g admitted to neonatal intensive care units of First Affiliated Hospital of Zhengzhou University were retrospectively studied.They were assigned into ART group and SC group according to their fertilization methods.Their general condition , major complications , respiratory support strategy , duration of hospital stay, hospitalization cost and mortality rate between the two groups were compared using t test, U test andχ^2 test.Result A total of 527 preterm infants were included , with an average gestational age of （ 30.6 ± 2.0） weeks （25.4 to 36.0 weeks） and an average birth weight of （1198 ±202） g （500 to 1490 g）. 88 infants were ELBW infants and 439 VLBW infants.156 infants were small for gestational age （ SGA ） infants and 371 appropriate for gestational age infants .According to their fertilization method , 81 infants were assigned into ART group and 446 infants SC group.The gestational age of ART group was lower than SC group, and the incidence of double/multiple birth was higher than SC group , the differences were statistically significant （P〈0.05）.Compared with SC group, the hospitalization duration and cost of ART group were significantly higher （ P 〈0.001 ） .The incidences of respiratory failure , bronchopulmonary dysplasia, sepsis, fungal infection, heart failure, disseminated intravascular coagulation and multiple organ dysfunction syndrome in ART group were higher than SC group （ 48.1% vs.34.8%, 50.6% vs.16.1%19.8%vs.7.0%, 8.6%vs.2.9%, 39.5%vs.17.7%, 22.2%vs.7.2%, 29.0%vs.15.0%） , and the incidence of hyperbilirubinemia was lower than SC group （81.5%vs.90.8%）.The differences were all statistically significant （P〈0.05）.No significant difference existed in respiratory support strategy between the two groups （ P〉0.05 ） .Conclusion Compared with spontaneous conception , ART method does not increase the risk of death among E/VLBW infants.However, ART conceived infants have potential risks of lower gestational age , higher double/multiple birth rates , higher complications incidences , longer hospitalization duration and higher hospitalization costs .Perinatal care and management are important for these infants.