超低和极低出生体重儿的危险因素及临床分析

Risk factors and clinical analysis of ultra-low and very low birth weight infants

目的:分析超低及极低出生体重儿母亲孕期危险因素,观察其出生后并发症、治疗效果及预后。方法:回顾性分析2015年10月—2017年10月收治的超低出生体重儿(ELBWI)及极低出生体重儿(VLBWI)的临床资料。结果:超低出生体重儿和极低出生体重儿共62例,其中胎龄<28周6例,28~31周30例,32~36周26例;出生体质量<1 000 g 5例,1 000~1 249 g 12例,1 250~1 499 g 45例。ELBWI/VLBWI母亲孕期危险因素前三位分别为:胎膜早破15例(24.2%),双胎或多胎14例(22.6%),妊娠期高血压综合征9例(14.5%)。ELBWI/VLBWI并发症前五位分别为:低蛋白血症(47例,75.8%)、新生儿高胆红素血症(46例,74.2%)、酸碱平衡紊乱31例(50.0%)、新生儿呼吸窘迫综合征(NRDS)(29例,46.8%)、贫血(27例,43.5%)。NRDS、贫血、呼吸暂停及喂养不耐受更多出现于<28周及28~31周的婴儿,新生儿窒息更多出现于出生体重<1000 g及1000~1 249 g的婴儿。62例患儿存活52例,死亡10例,死亡率为16.1%。ELBWI婴儿存活率为40.0%,VLBWI婴儿存活率为87.7%。引起死亡的主要原因为家属放弃治疗,其次为NRDS、重症感染和肺出血。结论:加强围产期保健、积极防治各种并发症可以提高ELBWI及VLBWI的存活率。

Objective： To analyze the risk factors of their mothers during pregnancy,observe the postnatal complications,treatment effects and prognosis.Methods： The clinical data of ultralow birth weight infants（ ELBWI） and very low birth weight infants（ VLBWI） admitted from October 2015 to October 2017 were analyzed retrospectively.Results： There were 62 cases of ELBWI and VLBWI,including 6 cases of gestational age 〈28 weeks,30 cases of 28 - 31 weeks,26 cases of 32 - 36 weeks,birth weight 1 000 g 5 cases,1 000 to 1 249 g 12 cases,1 250 - 1 499 g 45 cases.The top three risk factors of their mothers during pregnancy were premature rupture of membrane（ 15 cases,24.1%）,multiifetal pregnancy（ 14 cases,22.5%）,pregnancy induced hypertension syndrome（ 9 cases,1 4.5 %）.The top five complications of them were hypoprotenemia（ 47 cases,75.8%）,Neonatal hyperbilirubinemia（ 46 cases 74.1%）,disturbance of acid-base balance（ 31 cases,50.0%）,respiratory distress syndrome of newborn（ NRDS）（ 29 cases,46.7%）,hypohemia（ 27 cases,43.5%）.NRDS,hypohemia,apnea,feeding intolerance were more common in infants with 〈28 weeks and 28 - 31 weeks.Neonatal asphyxia were common in infants with birthweight 〈1000 g and of 1000 - 1249 g.The mortality of all 6 2 infants was 16.1 %.The survival rate of ELBWI was40.0%.and VLBWI 87.7%.The leading causes of death were discontinued treatments,RDS,severe infection and pulmonary hemorrhage.Conclusion： Improve perinatal medical care,prevent and treat various complications were effective methods to improve the survival rate of ELBWI and VLBWI.