经转运收入院的111例上气道梗阻新生儿临床特征及诊治结局

Clinical characteristics and outcomes of 111 neonates with upper airway obstruction admitted via transportation

目的总结经转运收入院的上气道梗阻(UAO)新生儿的临床特征及诊治结局,为这类患儿的临床管理提供更多循证依据。方法单中心病例总结,纳入2016年1月1日至2021年5月31日北京儿童医院新生儿中心经转运收住院、入院时<28日龄或校正年龄≤44周龄、第一诊断为UAO的病例,总结分析患儿的临床特点。根据UAO的不同部位分析病因、治疗、合并症及住院结局。采用四格表资料的χ^(2)检验比较不同部位UAO手术与非手术治疗患儿的转归。结果共纳入UAO患儿111例,占同期新生儿重症监护病房(NICU)4826例住院患儿的2.3%,其中男62例(55.9%),足月儿101例(91.0%),出生胎龄(38.7±2.0)周,出生体重(3207±585)g,入院时校正胎龄(40.8±2.5)周,入院体重(3221±478)g,其中35例患儿(31.5%)入院时已存在宫外生长发育迟缓,92例(82.9%)患儿在生后<1 d出现UAO的症状,25例(22.5%)入院前已明确UAO的具体病因诊断。最终因鼻、咽喉和颈部病变导致UAO的病例分别为24例(21.6%)、71例(64.0%)和16例(14.4%)。前5位病因分别为声带麻痹(28例)、双侧后鼻孔闭锁(20例)、咽软化(15例)、咽囊肿(7例)和声门下血管瘤(6例)。患儿入院后按“NICU-耳鼻喉-影像”多学科合作流程进行诊治,其中102例(91.9%)患儿进行了支气管纤维镜联合喉镜检查。70例(63.1%)患儿入院时需要气管插管呼吸支持。58例(52.3%)患儿实施了手术治疗,其中气管切开的患儿共16例,手术与非手术治疗患儿的治愈好转率为94.8%(55/58)比54.7%(29/53)、非医嘱离院率为1.7%(1/58)比45.3%(24/53),差异均有统计学意义(χ^(2)=24.21、30.11,均P<0.01)。结论新生儿UAO可发生于上气道不同部位,总体预后较好,多学科合作的诊治模式有助于明确梗阻部位及原因、正确评估病情和给予干预。

Objectives To analyze the clinical characteristics and outcomes of neonates with upper airway obstruction(UAO)who were admitted via transportation,hence to provide more evidence-based information for the clinical management of UAO.Methods This was a single center retrospective study.Patients were hospitalized in Beijing Children′s Hospital from January 1,2016 to May 31,2021 with age<28 days or postmenstrual age(PMA)≤44 weeks,and UAO as the first diagnosis.The general information of patients,obstructed sites in the upper airway,treatment,complications and prognosis were analyzed.The outcomes of surgical UAO vs.non-surgical UAO were analyzed by 2 by 2χ^(2) test.Results A total of 111 cases were analyzed(2.3%of the total NICU hospitalized 4826 infants in the same period),in which 62(55.9%)were boys and 101(91.0%)were term infants,and their gestational age was(38.7±2.0)weeks,birth weight(3207±585)g,PMA on admission(40.8±2.5)weeks and weight on admission was(3221±478)g.There were 92 cases(82.9%)with symptoms of UAO presenting on postnatal day 1,and 35 cases(31.5%)had extra-uterine growth retardation on admission.The diagnosis of UAO and the obstructive site was confirmed in 25 cases(22.5%)before transportation.There were 24 cases(21.6%),71 cases(64.0%),and 16 cases(14.4%)who had UAO due to nasal,throat,and neck problems,respectively.The top 5 diagnosis of UAO were vocal cord paralysis(28 cases),bilateral choanal atresia(20 cases),laryngomalacia(15 cases),pharynx and larynx cysts(7 cases),and subglottic hemangioma(6 cases).The diagnosis and treatment of all the patients followed a multidisciplinary approach consisted of neonatal intensive care unit,ear-nose-throat department and medical image departments.A total of 102 cases(91.9%)underwent both bronchofiberscope and fiber nasopharyngoscope investigation.Seventy cases(63.1%)required ventilation.Among the 58 cases(52.3%)who required surgical intervention,16 had tracheotomy.For cases with vs.without surgical intervention,the rate of cure and(or)improvement were 94.8%(55/58)vs.54.7%(29/53),and the rate of being discharged against medical arrangement were 1.7%(1/58)vs.45.3%(24/53)(χ^(2)=24.21 and 30.11,both P<0.01).Conclusions Neonatal UAO may locate at various sites of the upper airway.The overall prognosis of neonatal UAO is favorable.A multidisciplinary approach is necessary for efficient evaluation and appropriate surgical intervention.