探讨超低出生体重儿(ELBWI)住院、转归及随访情况。

选择2010年1月1日至2015年2月1日，于广西壮族自治区妇幼保健院新生儿科重症监护病房(NICU)住院治疗的129例ELBWI为研究对象。采用回顾性分析方法，收集其临床病例资料及随访资料，并对其孕母的一般临床资料、新生儿期常见临床症状、并发症发生情况、转归及出院后随访情况进行分析。统计学比较出生胎龄<28周与出生胎龄为≥28～32周存活出院的ELBWI呼吸治疗情况。

①本组129例ELBWI的孕母中，前3位妊娠期并发症依次为妊娠期高血压疾病(69.0%，89/129)，胎膜早破(37.2%，48/129)及妊娠期糖尿病(16.3%，21/129)。②本组129例ELBWI中，新生儿期前5位常见临床症状依次为呼吸困难(96.7%，126/129)，黄疸(85.3%，110/129)，反应差(77.5%，100/129)，腹胀(75.2%，97/129)，以及全身青紫(52.7%，68/129)。③本组129例ELBWI中，前6位新生儿期并发症依次为高胆红素血症(85.3%，110/129)，早产儿贫血(82.9%，107/129)，院内感染(81.4%，105/129)，呼吸窘迫综合征(RDS)(64.3%，83/129)，支气管肺发育不良(BPD)(50.4%，65/129)，以及喂养不耐受(50.4%，65/129)。④存活出院的ELBWI中，出生胎龄<28周ELBWI呼吸机辅助通气使用率及使用时间、连续气道正压通气(CPAP)使用率，均较出生胎龄为≥28～32周ELBWI显著增高或延长，并且差异均有统计学意义(χ²＝11.733，Z＝－4.963，χ²＝11.309；P<0.001)，但CPAP时间比较，差异无统计学意义(Z＝－1.550，P＝0.121)。⑤本组129例ELBWI中，98例治愈出院，1例因早产儿视网膜病(ROP)转至外院接受激光治疗，30例治疗无效死亡或家属放弃治疗后死亡。对99例存活出院ELBWI进行随访的结果显示，11例失访，失访率为11.1%(11/99)，88例完成随访；53.5%(53/99)听性脑干反应测听未通过，42.4%(42/99)合并ROP。完成随访的88例ELBWI中，运动、语言发育落后分别为12.5%(11/88)与4.5%(4/88)，仅36.4%(32/88)按时接受《盖塞尔发育量表》评估或于康复科接受随访。

ELBWI发生的常见原因为孕母妊娠期高血压疾病及胎膜早破。ELBWI新生儿期并发症多，出院后应密切随访。

To investigate the hospitalization, outcomes and follow-up results of extremely low birth weight infants (ELBWI).

From 1 January 2010 to 1 February 2015, a total of 129 cases of ELBWI in Neonatal Intensive Care Unit (NICU) of Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital were selected as research subjects. A retrospective analysis was conducted to collect their medical records and follow-up data and to analyze their mothers′ general clinical data, main clinical symptoms and complications in neonatal period, the outcomes and follow-up conditions after discharge from hospital. The respiratory therapy conditions between ELBWI with gestational age <28 weeks and ≥28-32 weeks were compared statistically.

①Among the 129 cases of ELBWI, the top three pregnancy complications of mothers of ELBWI were gestational hypertension diseases (69.0%, 89/129), premature rupture of membrane (37.2%, 48/129) and gestational diabetes mellitus (16.3%, 21/129), respectively. ②Among the 129 cases of ELBWI, the top five clinical symptoms in neonatal period were dyspnea (96.7%, 126/129), jaundice (85.3%, 110/129), poor response (77.5%, 100/129), abdominal distention (75.2%, 97/129), and body cyanosis (52.7%, 68/129), respectively. ③Among the 129 cases of ELBWI, the top six complications in neonatal period were hyperbilirubinemia (85.3%, 110/129), anemia of prematurity (82.9%, 107/129), nosocomial infection (81.4%, 105/129), respiratory distress syndrome (RDS)(64.3%, 83/129), bronchopulmonary dysplasia(BPD) (50.4%, 65/129) and feeding intolerance (50.4%, 65/129), respectively. ④Among the ELBWI who were alive and discharged from hospital, the usage rate and time of respirator assisted ventilation, the usage rate of continuous positive airway pressure (CPAP) in ELBWI with gestational age <28 weeks all were higher or longer than those in ELBWI with gestational age ≥28-32 weeks, and all the differences were statistically significant (χ²=11.733, Z=-4.963, χ²=11.309; P<0.001). But there was no statistical difference between them in the usage time of CPAP (Z=-1.550, P=0.121). ⑤Among the 129 cases of ELBWI, 98 cases were cured and discharged from hospital, 1 case was referred to another hospital for laser treatment due to ROP, 30 cases died as ineffective treatment or give-up treatment. The follow-up results of 99 alive and discharged cases showed that 11 cases failed to follow up and the rate was 11.1%(11/99), 88 cases were followed up successfully. And among the 99 cases, 53.5% (53/99) failed the auditory brainstem response audiometry test, 42.4% (42/99) cases were combined with ROP. Among the 88 cases who were followed up successfully, rates of motor and language development retardation were 12.5% (11/88) and 4.5% (4/88), respectively, and only 36.4% (32/88) received Gesell Developmental Scale assessment or follow-up in rehabilitation department regularly.

Gestational hypertension diseases and premature rupture of membrane are the common causes of ELBWI. And there are many complications in neonatal period of ELBWI, so we should take close follow-up after they discharge from hospitals.