足月新生儿非免疫性水肿的病因分析

Analysis of etiology of non-immune edema in term infants

目的探讨足月新生儿非免疫性水肿的病因及相关因素,为指导临床合理检查及治疗提供依据。方法收集2006-2015年首都医科大学附属北京儿童医院新生儿中心收治的非免疫性水肿的足月新生儿资料,分析其临床表现、辅助检查及治疗转归。结果符合标准的患儿25例,其中有围产期窒息缺氧史7例(28%),先天性心脏病6例(24%),单纯低蛋白血症3例(12%),生理性水肿3例(12%),输液过多造成的水肿3例(12%),单纯低钠血症2例(8%),先天性淋巴水肿2例(8%),单纯低钙血症1例(4%),怀疑染色体疾病1例(4%)。25例患儿中18例(72%)经治疗水肿消退,5例(20%)经治疗水肿未消退,2例(8%)放弃治疗。结论围产期缺氧窒息、先天性心脏病是引起足月新生儿非免疫性水肿的常见原因。新生儿水肿常多种病因并存,及时对症治疗效果较好。此外,医源性水肿也不少见。少见疾病如先天性淋巴水肿等,应提高警惕,防止误诊及漏诊。

Objective To explore the etiology and related factors of non-immune edema in the full-term infants in order to provide a reasonable basis for clinical examination and treatment. Methods The data of clinical manifestations,assistant examinations and treatment outcome of the full term infants with non-immune edema were summarized and analyzed in Beijing Children＇s Hospital during 2006-2015. Results There were 25 neonates who met diagnostic criteria. Seven cases（28%） were with perinatal asphyxia anoxia of the 25 patients, 6（24%） with congenital heart disease, 3（12%） with simply hypoproteinemia, physiological edema and excessive infusion respectively. Two cases（8%） with hyponatremia simple and congenital lymphedema respectively. One case（4%） with simple hypocalcemia and suspected chromosomal disease separately. 18 cases（72%） fully recovered after symptomatic treatment. Five cases（20%） did not subside. Two cases（8%） abandoned the treatment. Conclusion Perinatal asphyxia anoxia, congenital heart disease are the common causes of non-immune edema of term infants. Neonatal edema often coexists with multiple causes, and timely symptomatic treatment is better. In addition, the excessive infusion, iatrogenic edema is not uncommon. Rare diseases, such as congenital lymphedema should be vigilant to prevent misdiagnosis and missed diagnosis.