极低出生体重儿的临床干预和并发症的发生率及病死率研究

Mortality,Morbidity and Clinical Interventions of the Very Low Birth Weight Infants

目的 探讨极低出生体重儿主要并发症的特点及影响其存活率的相关因素 ,以便改进干预措施 ,进一步降低其病死率。 方法 对 1996年 1月～ 2 0 0 1年 12月于生后 2 4 h内转入 NICU的 12 2例极低出生体重儿的临床资料进行回顾性分析 ,并按出生体重分 3组 ,对其并发症的发生率、转归、主要死因、肠道喂养开始时间及体重变化情况等进行分析比较。 结果 导致极低出生体重的主要原因有多胎妊娠 (30 % )、妊娠合并症 (2 1% )、羊膜早破 (15 % )和原因不明 (30 % )等。所有患儿均有一种或多种并发症 ,主要为高血糖 (5 7% ) ,缺氧缺血性脑病 (46 % ) ,呼吸窘迫综合征 (33% ) ,感染(30 % ) ,低体温 (2 5 % ) ,呼吸暂停 (2 4 % ) ,脑室内出血 (18% )和动脉导管未闭 (18% )等。由于采取预防性干预措施 ,大多数并发症的发生率在不同体重组间的差异无显著性。本组极低出生体重儿存活率为 84 % ,若排除因经济困难或担心后遗症而放弃治疗后死亡的病例 ,则存活率为 91% ;其中出生体重≤ 10 0 0 g者为 5 9%。死亡的主要原因为呼吸窘迫综合征、感染和先天畸形。存活者能耐受经口胃管喂养开始时间为 (6± 4 ) d,不同出生体重之间差异无显著性 (F=1.36 ,P>0 .0 5 ) ;自行吸吮开始时间为 (2 3± 14 ) d,且随出生体重增加而?

Objective To investigate the characteristics of the major complications and the factors in relation to the improved hospital survival rate of very low birth weight infants(VLBWI). Methods The clinical data of 122 VLBWI who admitted to the NICU within 24 hours after birth were analyzed retrospectively by dividing patients into three groups according to the birth weight, that is, <or=1 000 g, ~1 250 g, ~1 500 g, respectively. The incidence of complications, outcomes, the primary causes of death, starting time of enteral feedings, time to regain birth weight and to reach 2 000 g were analyzed and compared. Results The major risk factors causing the premature birth of VLBWI were multiple births (30%), pregnancy complications (21%), and premature-rupture of membrane (15%). In 30% cases no reason could be found. All hospitalized VLBWI had at least one complication. The incidence of complications were: hyperglycemia (57%), hypoxia-ischemia encephalopathy (HIE, 46%), respiratory distress syndrome (RDS, 33%), infection (30%), hypothemia (25%), apnea (24%), intraventricular hemorrhage (IVH, 18%), and patent ductus arteriosus (PDA, 18%), and so on. There was no significant differences among the groups in the incidence of most complications because of taking preventive measures. The overall survival rate was 84%, and 59% for babies less than 1 000 grams. RDS, infection and congenital anomaly were the primary causes of death. The initial time of gavage feeding(well-tolerated) of survival VLBWI was (6±4) days, and there was no signicant differences among three groups ( F=1.36, P >0.05). The initial time of self-sucking was (23±14) days, and the larger the birth weight, the earlier the self-sucking ( F=1.36, P <0.05). Maximum weight loss and regaining birth weight for all VLBWI occurred at (6±3) days and (16±6) days, respectively, and no differences among the groups were observed ( F=2.95, P>0.05; F=1.13, P>0.05 ), while the age when the weight gain reached 2 000 g was (41±27) days, there was significant differences among the groups ( F=4.52,P < 0.05). Conclusions VLBWI are associated with high mortality and morbidity rates. Continuous postpartum careful monitoring and the early finding and treatment of complications are very important for the VLBWI. The authors emphasize the importance of preventing and treating in time apnea, RDS and PDA, avoiding iatrogenic hyperglycemia, preventing hospital-acquired infection, adopting conventional mechanical ventilation, high-frequency ventilation and surfactant replacement therapy appropriatly so as to improve outcomes of VLBWI.