探讨超低出生体重儿(ELBWI)的住院、转归及其随访情况。

选择2010年1月1日至2016年5月31日，于广西壮族自治区妇幼保健院、玉林市妇幼保健院、钦州市妇幼保健院等10家医疗机构的新生儿重症监护病房接受住院治疗的276例ELBWI为研究对象。对其临床病例资料及随访资料，进行回顾性分析，内容包括孕母及ELBWI一般临床资料，ELBWI新生儿期常见临床症状、并发症、转归及出院后随访情况等。采用χ²检验及Mann-Whitney U检验，对ELBWI出生胎龄<28周与出生胎龄≥28～32周，并存活出院者的呼吸支持治疗情况进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①本研究分娩ELBWI的209例孕妇中，双胎妊娠孕妇占31.6%(66/209)。这209例分娩ELBWI孕妇的前3位妊娠期并发症依次为：胎膜早破(27.3%，57/209)，妊娠期高血压疾病(19.6%，41/209)及妊娠期糖尿病(17.7%，37/209)。②本研究276例ELBWI中，新生儿期前4位常见临床症状依次为：呼吸困难(91.7%，253/276)，反应差(75.7%，209/276)，口唇或全身青紫(67.8%，187/276)及腹胀(40.6%，112/276)。③本研究276例ELBWI中，新生儿期前6位并发症依次为：高胆红素血症(81.2%，224/276)，呼吸窘迫综合征(RDS)(75.7%，209/276)，早产儿贫血(64.1%，177/276)，宫内感染性肺炎(50.0%，138/276)，支气管肺发育不良(BPD)(48.6%，134/276)及败血症(45.7%，126/276)。④存活出院的128例ELBWI中，出生胎龄<28周ELBWI的呼吸机辅助通气治疗率及治疗时间分别为92.6%和8.0 d(3.0～16.0 d)、连续气道正压通气(CPAP)治疗率及治疗时间，分别为96.3%和16.0 d(11.0～25.0 d)，均显著高于或长于出生胎龄≥28～32周者的67.2%、2.0 d(0～7.5 d)、73.4%、7.5 d(0～20.0 d)，并且差异均有统计学意义(χ²＝11.321、P＝0.001，Z＝－3.994、P<0.001，χ²＝11.329、P＝0.001，Z＝－3.301、P＝0.001)。⑤本研究276例ELBWI救治存活率为46.4%(128/276)，其中88例为治愈出院，40例为好转出院，137例(49.6%)死亡(36例因抢救无效死亡，101例因家属放弃治疗后很快死亡)，其余11例由家属签字出院后结局不详。⑥对128例存活出院ELBWI进行随访的结果显示，25例失访，失访率为19.5%(25/128)。103例完成随访ELBWI中，4例于生后6个月内死亡；48.1%(39/81)听性脑干反应测听未通过，69.4%(59/85)合并早产儿视网膜病(ROP)。完成随访并且存活的99例ELBWI中，运动、语言发育落后者分别占27.3%(27/99)、17.2%(17/99)，仅37.4%(37/99)按时接受《盖塞尔发育量表》评估，或于新生儿科/康复科接受随访。

ELBWI发生的常见原因为双胎、孕妇胎膜早破及妊娠期高血压疾病。ELBWI新生儿期并发症多，死亡率高，出院后应对其密切随访。

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

From 1 January 2010 to 31 May 2016, a total of 276 cases of ELBWI who were hospitalized in neonatal intensive care unit of 10 medical institutions, including Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region, Maternal & Child Health Hospital of Yulin, Maternal & Child Health Hospital of Qinzhou, etc., were chosen as research subjects. Clinical case data and follow-up results of the ELBWI were analyzed retrospectively, including general clinical data of ELBWI and their mothers, common clinical symptoms, complications, sequelaes and follow-up conditions of ELBWI. Among survival and discharged ELBWI, the respiratory therapy between gestational age <28 weeks and ≥28-32 weeks ELBWI were compared statistically by chi-square test and Mann-Whitney U test. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

① General informations of 209 mothers of ELBWI in this study: the twin pregnancy rate was 31.6% (66/209). Top three pregnancy complications in turn of 209 mothers were premature rupture of membrane (27.3%, 57/209), gestational hypertension diseases (19.6%, 41/209) and gestational diabetes mellitus (17.7%, 37/209). ②Top four clinical symptoms in turn of 276 cases of ELBWI in neonatal period were dyspnea (91.7%, 253/276), poor response (75.7%, 209/276), cyanosis of lips or whole body (67.8%, 187/276) and abdominal distention (40.6%, 112/276). ③Top six complications in turn of 276 cases of ELBWI in neonatal period were hyperbilirubinemia (81.2%, 224/276), respiratory distress syndrome (RDS) (75.7%, 209/276), anemia of prematurity (64.1%, 177/276), intrauterine infectious pneumonia (50.0%, 138/276), bronchopulmonary dysplasia (BPD) (48.6%, 134/276) and sepsis (45.7%, 126/276). ④Among 128 cases of ELBWI who were alive and discharged from hospitals, the rate of treatment and duration of respirator assisted ventilation of ELBWI with gestational age <28 weeks were 92.6% and 8.0 d (3.0-16.0 d), respectively, the rate of treatment and duration of continuous positive airway pressure (CPAP) of ELBWI with gestational age <28 weeks were 96.3% and 16.0 d (11.0-25.0 d), respectively, which were all much higher or longer than those of 67.2%, 2.0 d (0-7.5 d), 73.4%, 7.5 d (0-20.0 d) in ELBWI with gestational age ≥28-32 weeks, and all differences were statistically significant (χ²=11.321, P=0.001; Z=-3.994, P<0.001; χ²=11.329, P=0.001; Z=-3.301, P=0.001). ⑤ The survival rate of 276 cases of ELBWI in this study was 46.4%(128/276). Among 276 cases of ELBWI, a total of 88 cases were cured and 40 cases were improved when discharged from hospitals, and 137 cases (49.6%) died in hospitals as ineffective treatments (36 cases) or their guardians gave up treatment to their ELBWI (101 cases), and outcomes of another 11 cases was unknown after they discharged from hospitals by their guardians′ signature. ⑥ Follow-up results of 128 alive and discharged cases showed that 25 cases followed up uncompleted, and the missing rate in this study was 19.5% (25/128). Among 103 cases of ELBWI who followed up successfully, 4 of them died within 6 months after birth. Among infants who have completed follow-up, 48.1%(39/81) of them failed to pass the auditory brainstem response audiometry test, 69.4% (59/85) of them had been diagnosed of retinopathy of prematurity (ROP). Among 99 survival cases who were followed up successfully, ratio of motor and language development retardation were 27.3% (27/99) and 17.2% (17/99), respectively, and only 37.4% (37/99) of them assessed by Gesell Developmental Scale or followed up regularly in neonatology/rehabilitation department.

The twin birth, premature rupture of membrane and gestational hypertension diseases of mother are the common causes of ELBWI. There are many complications and high mortality rate during the neonatal period of ELBWI. We should take close follow-up after ELBWI discharging from hospitals.