超未成熟儿与超低出生体重儿临床救治结局分析

A study on the clinical outcomes of extremely preterm infants and extremely low birth weight infants

目的探讨宫内不同生长状态对超未成熟儿(extremely preterm infants,EPI)与超低出生体重儿(extremely low birth weight infants,ELBWI)临床救治结局的影响。方法收集广东省26家三级甲等医院新生儿科2013—2017年出院的EPI与ELBWI病例资料进行非干预性前瞻性研究,根据出生胎龄和出生体重分为A组(出生胎龄<28周且出生体重<1000 g)、B组(出生胎龄<28周但出生体重≥1000 g)和C组(出生胎龄≥28周但出生体重<1000 g),比较3组患儿存活率和并发症发生率。结果共2392例患儿纳入分析,出生胎龄(27.7±1.9)周(22~36周),出生体重(919±158)g(300~1750 g);其中A组948例(39.6%),B组571例(23.9%),C组873例(36.5%)。A组存活率[49.5%(469/948)]低于B组[68.0%(388/571)]和C组[67.4%(588/873)](P<0.001),B组和C组比较差异无统计学意义(P>0.05)。A组支气管肺发育不良、早产儿视网膜病发生率高于B组,坏死性小肠结肠炎发生率低于B组,新生儿呼吸窘迫综合征、支气管肺发育不良、早产儿视网膜病、脑室周围-脑室内出血、动脉导管未闭发生率高于C组,坏死性小肠结肠炎发生率低于C组;B组新生儿呼吸窘迫综合征、支气管肺发育不良、脑室周围-脑室内出血、动脉导管未闭发生率高于C组,差异均有统计学意义(P<0.05)。结论宫内生长状态影响EPI和ELBWI的存活率和并发症发生率,出生胎龄和出生体重对存活率的影响具有同等重要性,而出生胎龄对新生儿呼吸窘迫综合征、支气管肺发育不良、脑室周围-脑室内出血、动脉导管未闭等并发症的影响较出生体重更大。

Objective To study the influences of different intrauterine growth patterns on clinical outcomes of extremely preterm infants(EPI)and extremely low birth weight infants(ELBWI).Method From 2013 to 2017,the clinical records of EPI and ELBWI discharged from the Neonatology Department of our hospitals were collected.Preterm infants were assigned into three groups according to their gestational age(GA)and birth weight(BW),Group A:GA<28 w,BW<1000 g;Group B:GA<28 w,BW≥1000 g;Group C:GA≥28 w,BW<1000 g.The survival rate and incidences of complications among groups were compared.Result A total of 2392 preterm infants were included,with GA of(27.7±1.9)w(range from 22~36 w)and BW of(919±158)g(range from 300~1750 g).The number and percentage of infants in Group A,B and C were 948(39.6%),571(23.9%)and 873(36.5%),respectively.The survival rate of Group A(49.5%,469/948)was lower than Group B(68.0%,388/571)and Group C(67.4%,588/873)(P<0.001).No significant difference existed between Group B and Group C in survival rate(P>0.05).Compared with Group B,Group A had higher incidences of bronchopulmonary dysplasia(BPD)and retinopathy of prematurity(ROP)[87.1%(417/479)vs.80.4%(303/377),49.5%(262/529)vs.36.0%(144/400)],and lower incidence of necrotizing enterocolitis(NEC)[8.3%(58/696)vs.13.6%(66/486)](P<0.05).Compared with Group C,Group A had higher incidences of neonatal respiratory distress syndrome(RDS),BPD,ROP,periventricular-intraventricular hemorrhage(PIVH)and patent ductus arteriosus(PDA)[91.0%(863/948)vs.86.4%(754/873),87.1%(417/479)vs.54.8%(321/586),49.5%(262/529)vs.35.6%(219/615),37.1%(263/709)vs.22.6%(156/689),30.3%(283/935)vs.21.9%(185/843)],and lower incidence of NEC[8.3%(58/696)vs.15.3%(113/740)](P<0.05).The incidence of neonatal RDS,BPD,PIVH and PDA in Group B was higher than Group C[89.8%(513/571)vs.86.4%(754/873),80.4%(303/377)vs.54.8%(321/586),34.0%(159/467)vs.22.6%(156/689),28.6%(157/549)vs.21.9%(185/843)](P<0.05).Conclusion Survival rate and incidences of complications of EPI and/or ELBWI were influenced by intrauterine growth patterns.GA and BW has equally important effects on survival rate,and GA has greater influences than BW on associated complications.