极低及超低出生体重儿的预后因素分析

王恋, 李娟, 毛健, 张静, 陈丹

中国当代儿科杂志 ›› 2014, Vol. 16 ›› Issue (6) : 601-605.

PDF(1227 KB)
HTML
PDF(1227 KB)
HTML
中国当代儿科杂志 ›› 2014, Vol. 16 ›› Issue (6) : 601-605. DOI: 10.7499/j.issn.1008-8830.2014.06.008
论著·临床研究

极低及超低出生体重儿的预后因素分析

  • 王恋, 李娟, 毛健, 张静, 陈丹
作者信息 +

Prognostic factors in very low birth weight infants and extremely low birth weight infants

  • WANG Lian, LI Juan, MAO Jian, ZHANG Jing, CHEN Dan
Author information +
文章历史 +

摘要

目的 分析极低及超低出生体重儿(出生体重≤ 1 200 g)的临床资料,为其预后及临床干预提供预警指标。方法 回顾性分析108 例极低及超低出生体重儿的母孕期病史、新生儿出生时情况、诊治经过及预后,采用非条件logistic 回归分析筛选预后的影响因素。结果 108 例极低及超低出生体重儿,出生体重范围在<800 g,800~999 g 和1000~1200 g 的早产儿分别为15 例、29 例和64 例。存活72 例,死亡36 例,病死率为33.3%。前置胎盘、5 分钟 Apgar ≤ 3 分是导致这些早产儿出生24 h 内死亡的主要危险因素;胎膜早破、5 分钟 Apgar ≤ 3 分及肺出血是生后24 h 至7 d 内死亡的危险因素;出生7 d 后死亡的独立危险因素是侵袭性真菌感染导致的晚发型败血症,妊高征是这个阶段早产儿死亡的保护因素。结论 极低及超低出生体重儿的病死率较高,且随着日龄的增加,影响早产儿生存的预后因素不同,临床上应针对这些因素制定合理的管理方案,提高早产儿生存率。

Abstract

Objective To analyze the clinical data of very low birth weight infants (VLBWIs) and extremely low birth weight infants (ELBWIs) (birth weight ≤1 200 g) and to provide prewarning indicators for prognostic evaluation and clinical intervention. Methods A retrospective analysis was performed on the clinical data of 108 VLBWIs and ELBWIs to investigate the maternal history of diseases during pregnancy, neonatal birth status, the process of diagnosis and treatment, and prognosis. Unconditional logistic regression analysis was used to determine prognostic factors. Results Of the 108 preterm infants, 15 had a birth weight of <800 g, 29 had a birth weight of 800-999 g, and 64 had a birth weight of 1000-1200 g. The mortality was 33.3% (36/108). Placenta previa and Apgar score ≤3 at 5 minutes were the main risk factors for death within 24 hours of birth; premature rupture of membrane, Apgar score ≤3 at 5 minutes, and pulmonary hemorrhage were the main risk factors for death between 24 hours and 7 days after birth; late-onset sepsis caused by invasive fungal infection was an independent risk factor for death over 7 days after birth, while pregnancyinduced hypertension syndrome was a protective factor. Conclusions The mortality in VLBWIs and ELBWIs is relatively high, and the prognostic factors vary between preterm infants of different ages. Clinicians should discuss management options for the infants on the basis of these findings to increase the survival of preterm infants.

关键词

预后 / 病死率 / 极低出生体重儿 / 超低出生体重儿

Key words

Prognosis / Mortality / Very low birth weight infant / Extremely low birth weight infant

引用本文

导出引用
王恋, 李娟, 毛健, 张静, 陈丹. 极低及超低出生体重儿的预后因素分析[J]. 中国当代儿科杂志. 2014, 16(6): 601-605 https://doi.org/10.7499/j.issn.1008-8830.2014.06.008
WANG Lian, LI Juan, MAO Jian, ZHANG Jing, CHEN Dan. Prognostic factors in very low birth weight infants and extremely low birth weight infants[J]. Chinese Journal of Contemporary Pediatrics. 2014, 16(6): 601-605 https://doi.org/10.7499/j.issn.1008-8830.2014.06.008

参考文献

[1] Goldenberg RL, Culhane JF, Iams JD, et al. Epidemiology and causes of preterm birth[J].Lancet, 2008, 371(9606): 75-84.
[2] 李娟, 王庆红, 吴红敏, 等. 2005 年中国城市产科新生儿出 生状况调查[J].中国当代儿科杂志, 2012, 14(1): 7-10.
[3] Navaei F, Aliabady B, Moghtaderi J, et al. Early outcome of preterm infants with birth weight of 1500 g or less and gestational age of 30 weeks or less in Isfahan city, Iran[J].World J Pediatr,2010, 6(3): 228-232.
[4] 邹坤, 谢火华, 王颖. 极低出生体重儿的发生及死亡原因分 析[J].中国妇幼保健, 2005, 20(15): 1886-1887.
[5] 邵肖梅, 叶鸿瑁, 邱小汕. 实用新生儿学[M]. 第4 版. 北京: 人民卫生出版社.
[6] Iijima S, Arai H, Ozawa Y, et al.Clinical patterns in extremely preterm (22 to 24 weeks of gestation) infants in relation to survival time and prognosis[J].Am J Perinatol, 2009, 26(6): 399-406.
[7] Sritipsukho S, Suarod T, Sritipsukho P. Survival and outcome of very low birth weight infants born in a university hospital with level II NICU[J].J Med Assoc Thai, 2007, 90(7): 1323-1329.
[8] Mally PV, Bailey S, Hendricks-Munoz KD. Clinical issues in the management of late preterm infants[J].Curr Probl Pediatr Adolesc Health Care, 2010, 40(9): 218-233.
[9] Wang Y, Tanbo T, Ellingsen L, et al. Effect of pregestational maternal, obstetric and perinatal factors on neonatal outcome in extreme prematurity[J].Arch Gynecol Obstet, 2011, 284(6): 1381- 1387.
[10] Corchia C, Ferrante P, Da Frè M, et al. Cause-specific mortality of very preterm infants and antenatal events[J].J Pediatr, 2013, 162(6): 1125-1132.
[11] Gotsch F, Romero R, Kusanovic JP, et al. The fetal inflammatory response syndrome[J].Clin Obstet Gynecol, 2007, 50(3): 652-683.
[12] Moyo SR, Hagerstrand I, Nystrom L, et al. Stillbirths and intrauterine infection, histologic chorioamnionitis and microbiological findings[J].Int J Gynaecol Obstet, 1996, 54(2): 115-123.
[13] Cruz Martinez M, Redondo Aguilar R, Cano Aguilar A, et al. Analysis of perinatal mortality in newborn infants with a birth weight of less than 1000 grams in Hospital San Cecilio in Granada (Spain) over the 1991-2010 period[J].Arch Argent Pediatr, 2013, 111(1): 45-52.
[14] Crowther CA, McKinlay CJ, Middleton P, et al. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes[J].Cochrane Database Syst Rev, 2011, (6): CD003935.
[15] Blumenfeld YJ, Lee HC, Gould JB, et al. The effect of preterm premature rupture of membranes on neonatal mortality rates[J].Obst Gynecol, 2010, 116(6): 1381-1386.
[16] Easterling TR, Benedetti TJ, Schmucker BC, et al. Maternal hemodynamics in normal and preeclamptic pregnancies: a longitudinal study[J].Obst Gynecol, 1990, 76(6): 1061-1069.
[17] Hornik CP, Fort P, Clark RH, et al. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units[J].Early Hum Dev, 2012, 88(2): S69-S74.
[18] Lim WH, Lien R, Huang YC, et al. Prevalence and pathogen distribution of neonatal sepsis among very-low-birth-weight infants[J].Pediatr Neonatol, 2012, 53(4): 228-234.
[19] Montagna MT, Lovero G, De Giglio O, et al. Invasive fungal infections in neonatal intensive care units of Southern Italy: a multicentre regional active surveillance (AURORA project)[J].J Prev Med Hyg, 2010, 51(3): 125-130.
[20] 陈超. 新生儿真菌感染的诊治[J].中国实用儿科杂志, 2011, 26(1): 3-6.

PDF(1227 KB)
HTML

Accesses

Citation

Detail

段落导航
相关文章

/