我国25家Ⅲ级新生儿重症监护病房极低出生体重儿出院结局的横断面调查

Outcomes of very low birth weight infants at discharge： a multicentered cross-sectional study of 25 tertiary neonatal intensive care units in China

目的统计极低出生体重儿 （verylow birth weight infant, VLBW1）的病死率及早产儿主要疾病发生率，为临床决策及后续流行病学研究提供基线参考数据。方法应用“基于证据的质量改进方法降低我国新生儿重症监护室院内感染发生率的整群随机对照试验”研究的第一年（2015年5月至2016年4月）的基线数据。协作单位为我国19个省级行政区域的25家Ⅲ级新生儿重症监护病房。研究对象为所有胎龄〈34＋0周、出生体重〈1500g、生后7d内入住协作单位新生儿重症监护病房的新生儿。通过标准数据库采集临床数据。采用描述性统计分析。结果研究期间其纳入VLBWI2956例，包括446例（15．1％）超低Ⅲ生体重儿 （extermely low birth weightinfant, ELBWI）。所有患儿中22．6％（668／2956）自动出院。积极治疗患儿的院内病死率为8．0％（182／2288），积极治疗的ELBWI院内病死率为27．3％（83／304），出生体重1000～1499g患儿的院内病死率为5．0％（99／1984）。所有患儿的总病死率为23．9％（705／2956），ELBWI的总病死率为47．5％（212／446）。VLBWI主要早产儿疾病——败血症、支气管肺发育不良、≥Ⅲ度脑室内出血或脑室周围白质软化、≥Ⅱ期坏死小肠结肠炎以及早产儿视网膜病（≥Ⅲ期）的发生率分别为23．9％（707／2956）、18．9％（432／2288）、11．5％（283／2469）、5．6％（144／2561）和3．4％（61／1795）；在ELBWI中这几种疾病的发生率分圳为28．9％（129／446）、49．0％（149／304）、21．6％（68／315）、7．2％（23／318）和13．9％（29／208）。45．9％（1050／2288）的积极治疗患儿在住院期间死亡或至少发生1种早产儿主要疾病；ELBWI死亡或以上任意早产儿主要疾病发生率为76．0％（231／304）。结论新生儿重症监护病房住院VLBWI的病死率及早产儿主要疾病发生率高，需进一步评价并改进目前的诊疗策略以改善其预后。

Objective To investigate the mortality and incidence of major diseases in preterm very low birth weight infants （VLBWI） in order to provide baseline data for clinical decision making and further epidemiological studies. Methods This was a multicentered cross-sectional study and a sub-analysis of baseline data from ＂REduction of Infection in Neonatal intensive care units using the Evidence-based Practice for Improving Quality （REIN-EPIQ）＂ study, which was a multicentered cluster randomized controlled study. This study was conducted in 25 tertiary neonatal intensive care unit （NICU） in 19 provinces and major cities of China. All infants with gestational age less than 34 weeks, birth weight less than 1 500 g and admission within the first seven days of life from May 2015 to April 2016 were enrolled. Clinical information of those enrolled infants was extracted from the standardized database. Descriptive statistical analysis was used. Results A total of 2 956 VLBWI were enrolled with 446 （15.1%） extremely low birth weight infants （ELBWI）. Overall, 22.6% （668/ 2 956） infants were brought home by their parents against medical advice. Among those stayed in the hospital, the in-hospital mortality of VLBWI was 8.0% （182/2 288）, and that of ELBWI was 27.3% （83/304）. The in-hospital mortality of infants with birth weight between 1 000 and 1 499 g was 5.0% （99/1 984）. The estimated overall mortality, was 23.9% （705/2 956） and 47.5% （212/446） for ELBWI. Incidences of sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage （grade Ⅲ or above） or periventricular leucomalaeia, necrotizing enterocolitis （stage Ⅱ or above） and retinopathy of prematurity （stageⅢ or above） were 23.9% （707/2 956）, 18.9% （432/2 288）, 11.5% （283/2 469）, 5.6% （144/2 561） and 3.4% （61/1 795） in VLBWI, respectively, and 28.9% （129/446）, 49.0% （149/304）, 21.6% （68/315）, 7.2% （23/318） and 13.9% （29/208） in ELBWI. Among infants who received active care, 45.9% （1 050/2 288） died or had at least one major preterm disease during hospitalization, and that of ELBWI was 76.0% （231/304）. Conclusion The mortality and incidences of major preterm diseases are significantly high among VLBWI in NICU. Further investigations on current practices and quality improvement are needed to improve the overall outcome of VLBWI.