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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2019, Vol. 15 ›› Issue (04): 444 -452. doi: 10.3877/cma.j.issn.1673-5250.2019.04.015

Special Issue: ；

Original Article

Research of hospitalization, outcomes and follow-up results of extremely low birth weight infants

Liping Yao1, Danhua Meng1,†(), Qiufen Wei1, Yan Li1, Wuhua Liang2, Haiyan Huang3, Hong Zhen4, Shuying Zhang5, Yi Wei6, Chaobo Wu7, Yancheng Wei8, Junxin Zhou9, Guoxiu Lu10   

  1. 1. Department of Neonatology, Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning 530003, Guangxi Zhuang Autonomous Region, China
    2. Department of Neonatology, Maternal & Child Health Hospital of Yulin, Yulin 537000, Guangxi Zhuang Autonomous Region, China
    3. Department of Neonatology, Maternal & Child Health Hospital of Qinzhou, Qinzhou 535000, Guangxi Zhuang Autonomous Region, China
    4. Department of Neonatology, People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530003, Guangxi Zhuang Autonomous Region, China
    5. Department of Neonatology, Nanning Maternal & Child Health Hospital, Nanning 530003, Guangxi Zhuang Autonomous Region, China
    6. Department of Neonatology, Maternal & Child Health Hospital of Guilin, Guilin 541000, Guangxi Zhuang Autonomous Region, China
    7. Department of Neonatology, Ethnic Hospital of Guangxi Zhuang Autonomous Region, Nanning 530003, Guangxi Zhuang Autonomous Region, China
    8. Department of Neonatology, People′s Hospital of Hechi, Hechi 547000, Guangxi Zhuang Autonomous Region, China
    9. Department of Neonatology, People′s Hospital of Bobai County, Yulin 537600, Guangxi Zhuang Autonomous Region, China
    10. Department of Neonatology, First People′s Hospital of Hechi, Hechi 547000, Guangxi Zhuang Autonomous Region, China
  • Received:2018-10-14 Revised:2019-06-10 Published:2019-08-01
  • Corresponding author: Danhua Meng
  • About author:
    Corresponding author: Meng Danhua, Email:
  • Supported by:
    Self-Financing Research Project of Health and Family Planning Commission of Guangxi Zhuang Autonomous Region(Z2016091, Z20170787, Z20170788, Z20170789, Z20180084)
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Objective

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

Methods

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.

Results

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.

Conclusions

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.

Key words: Hospitalization, Outcomes, Evoked potentials, auditory, brain stem, Retinopathy of prematurity, Survival rate, Infant, extremely low birth weight
表1 本研究分娩超低出生体重儿的209例孕妇一般临床资料[例数(%)]
一般临床资料 构成比或发生率 一般临床资料 构成比或发生率
年龄(岁) ? 本次妊娠胚胎数 ?
? <20 6(2.9) ? 单胎 140(67.0)
? 20～35 175(83.7) ? 双胎 66(31.6)
? >35～45 28(13.4) ? 3胎 3(1.4)
受孕方式 ? ? 妊娠期并发症 ?
? 自然受孕 169(80.9) ? 胎膜早破 57(27.3)
? 辅助生殖技术 40(19.1) 妊娠期高血压疾病 41(19.6)
分娩前是否使用激素 ? ? 妊娠期糖尿病 37(17.7)
? 是 100(47.8) ? 宫内感染 31(14.8)
? 否 109(52.2) ? 胆汁淤积综合征 19(9.1)
分娩方式 ? ? 胎盘早剥 18(8.6)
? 自然分娩 138(66.0) ? 前置胎盘 9(4.3)
? 助产 9(4.3) ? ? ?
? 剖宫产术分娩 62(29.7) ? ? ?
表2 本研究276例超低出生体重儿一般临床资料[例数(%)]
一般临床资料 构成比或发生率 一般临床资料 构成比或发生率
性别 ? 常见临床症状 ?
? 男 162(58.7) ? 呼吸困难 253(91.7)
? 女 114(41.3) ? 反应差 209(75.7)
出生胎龄(周) ? ? 口唇或全身青紫 187(67.8)
? ≥24＋5～28 145(52.5) ? 腹胀 112(40.6)
? ≥28～32 113(41.0) ? 低体温 55(19.9)
? ≥32～37 18(6.5) ? 肝大 38(13.8)
是否发生胎儿窘迫 ? ? 呕吐 35(12.7)
? 是 43(15.6) ? 发热 34(12.3)
? 否 226(81.9) ? 抽搐 30(10.9)
? 不详 7(2.5) ? 脾大 19(6.9)
出生后1 min Apgar评分(分) ? ? 便血 10(3.6)
? 0～3 31(11.2) ELBWI类型 ?
? 4～7 86(31.2) ? 匀称型SGA儿 67(24.3)
? ≥8 159(57.6) ? 非匀称型SGA儿 75(27.2)
出生后5 min Apgar评分(分) ? ? 适于胎龄儿 134(48.6)
? 0～3 15(5.4) ? 大于胎龄儿 0(0)
? 4～7 48(17.4) ? ? ?
? ≥8 213(77.2) ? ? ?
表3 本研究276例超低出生体重儿新生儿期并发症发生情况[例数(%)]
并发症 发生率 并发症 发生率 并发症 发生率
高胆红素血症 224(81.2) 低血糖症 69(25.0) 胆汁淤积综合征 27(9.8)
RDS 209(75.7) PDA 61(22.1) VAP 26(9.4)
早产儿贫血 177(64.1) IVH 58(21.0) 高血糖症 23(8.3)
宫内感染性肺炎 138(50.0) ? Ⅲ级以上 15(5.4) 低钙血症 19(6.9)
BPD 134(48.6) NEC 37(13.4) 化脓性脑膜炎 9(3.3)
败血症 126(45.7) ? Ⅰ期 9(3.3) 甲状腺功能低下 6(2.2)
房间隔缺损 114(41.3) ? Ⅱ期 12(4.3) 气胸 5(1.8)
喂养不耐受 106(38.4) ? Ⅲ期 6(2.2) 湿肺 3(1.1)
院内感染 105(38.0) 宫内感染 34(12.3) ? ?
表4 本研究出生胎龄<28周与≥28～32周存活出院的超低出生体重儿，接受呼吸支持治疗情况比较
出生胎龄(周) 例数 呼吸机辅助通气治疗[例数(%)] 呼吸机辅助通气治疗时间[d，M(P25～P75)] CPAP治疗[例数(%)] CPAP治疗时间[d，M(P25～P75)]
<28 54 50(92.6) 8.0(3.0～16.0) 52(96.3) 16.0(11.0～25.0)
≥28～32 64 43(67.2) 2.0(0～7.5) 47(73.4) 7.5(0～20.0)
检验值 ? χ2＝11.321 Z＝－3.994 χ2＝11.329 Z＝－3.301
P值 ? 0.001 <0.001 0.001 0.001
表5 本研究128例存活出院超低出生体重儿的转归及随访[%(n/n′)]
项目 发生率 项目 发生率 项目 发生率
随访情况 ? ROP 69.4(59/85) 身高 ?
? 完成随访 80.5(103/128) ? Ⅰ期 32.9(28/85) ? <同龄儿第10百分位数 51.5(51/99)
? 失访 19.5(25/128) ? Ⅱ期 17.6(15/85) ? ＝同龄儿第10百分位数 8.1(8/99)
听性脑干反应测听 63.3(81/128) ? Ⅲ期 11.8(10/85) ? >同龄儿第25百分位数 9.1(9/99)
? 通过 51.9(42/81) ? Ⅳ期或Ⅴ期 7.1(6/85) 体重 ?
? 未通过 48.1(39/81) 精神运动发育 ? ? <同龄儿第10百分位数 49.5(49/99)
EUGR a ? ? 运动发育落后 27.3(27/99) ? ＝同龄儿第10百分位数 9.1(9/99)
? 有 69.7(69/99) ? 语言发育落后 17.2(17/99) ? >同龄儿第25百分位数 8.1(8/99)
? 无 30.3(30/99) ? 正常 56.5(56/99) ? ? ?
反复喘息发作 21.2(21/99) 反复呼吸道感染 13.1(13/99) ? ? ?
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