摘要
目的探讨广东省超未成熟双胎儿临床救治结局及变化趋势。方法回顾性选择2008年1月至2017年12月广东省26家三级甲等医院新生儿科入院的胎龄<28周双胎儿269对,按照入院年份分为前5年组和后5年组,双胎中以出生体重高低分为重婴和轻婴。收集孕母围生期和新生儿住院资料,分析前、后5年双胎儿存活率、并发症发生率的差异。结果后5年组超未成熟双胎儿、双胎中重婴、双胎中轻婴的重度窒息发生率、出生头围低于前5年组(P<0.05)。后5年组超未成熟双胎儿均死亡的比例低于前5年组,且后5年组双胎中重婴、双胎中轻婴的病死率低于前5年组(P<0.05)。后5年组双胎中重婴、双胎中轻婴肺出血、动脉导管未闭、脑室周围-脑室内出血、新生儿呼吸窘迫综合征的发生率均低于前5年组,支气管肺发育不良发生率高于前5年组(均P<0.05)。结论广东省26家三级甲等医院入院的胎龄<28周超未成熟双胎儿的存活率显著上升,且双胎内无论是重婴还是轻婴,发生重度窒息、肺出血、动脉导管未闭、脑室周围-脑室内出血、新生儿呼吸窘迫综合征的比例均明显下降,而发生支气管肺发育不良比例增加。伴随诊疗水平提升,未来需要由产前诊断、产科、新生儿科等组成多学科协作,共同制定科学的双胎妊娠管理策略。[中国当代儿科杂志,2022,24(1):33-40]
Objective To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China. Methods A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups. Results Compared with the 2008-2012 group, the 2013-2017 group(both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth(P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group(P<0.05).Compared with the 2008-2012 group, the 2013-2017 group(both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus(PDA), periventricular-intraventricular hemorrhage(P-IVH), and neonatal respiratory distress syndrome(NRDS) and a higher incidence rate of bronchopulmonary dysplasia(P<0.05). Conclusions There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province.The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.[Chinese Journal of Contemporary Pediatrics, 2022, 24(1): 33-40]
作者
石碧君
李颖
吴繁
冯周善
崔其亮
杨传忠
叶晓彤
戴怡蘅
梁伟怡
叶秀桢
莫镜
丁璐
吴本清
陈宏香
黎炽旺
张喆
荣箫
沈薇
黄为民
杨冰岩
吕峻峰
黄辉文
霍乐颖
饶红萍
严文康
任雪军
杨勇
王方方
刘东
刁诗光
刘晓燕
孟琼
王玉
王斌
张丽娟
黄宇戈
敖当
李伟中
陈洁玲
陈艳玲
李薇
陈志凤
丁月琴
李晓瑜
黄越芳
林霓阳
蔡扬帆
韩莎莎
金雅
柳国胜
万忠和
班奕
白波
李广洪
严越秀
超未成熟儿与超低出生体重儿研究协作组
SHI Bi-Jun;LI Ying;WU Fan;FENG Zhou-Shan;CUI Qi-Liang;YANG Chuan-Zhong;YE Xiao-Tong;DAI Yi-Heng;LIANG Wei-Yi;YE Xiu-Zhen;MO Jing;DING Lu;WU Ben-Qing;CHEN Hong-Xiang;LI Chi-Wang;ZHANG Zhe;RONG Xiao;SHEN Wei;HUANG Wei-Min;YANG Bing-Yan;LYU Jun-Feng;HUANG Hui-Wen;HUO Le-Ying;RAO Hong-Ping;YAN Wen-Kang;REN Xue-Jun;YANG Yong;WANG Fang-Fang;LIU Dong;DIAO Shi-Guang;LIU Xiao-Yan;MENG Qiong;WANG Yu;WANG Bin;ZHANG Li-Juan;HUANG Yu-Ge;AO Dang;LI Wei-Zhong;CHEN Jie-Ling;CHEN Yan Ling;LI Wei;CHEN Zhi-Feng;DING Yue-Qin;LI Xiao-Yu;HUANG Yue-Fang;LIN Ni-Yang;CAI Yang-Fan;HAN Sha Sha;JIN Ya;LIU Guo-Sheng;WAN Zhong-He;BAN Yi;BAI Bo;LI Guang-Hong;YAN Yue-Xiu(Collaboration Study Group for Extremely Preterm and Extremely Low Birth Weight Infants.Department of Pediatrics,Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China)
出处
《中国当代儿科杂志》
CAS
CSCD
北大核心
2022年第1期33-40,共8页
Chinese Journal of Contemporary Pediatrics
基金
广东省科技计划项目(2017ZC0254)。
关键词
双胎儿
病死率
并发症
出生体重
超未成熟儿
Twins
Mortality rate
Complication
Birth weight
Extremely preterm infant