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目的对胎龄低于28周极不成熟早产儿病死率、并发症及其高危因素进行分析与评估,为该类早产儿的临床决策提供参考。方法回顾性分析美国圣路易斯华盛顿大学儿童医院新生儿重症监护室(NICU)2005年1月至2007年8月收治的219例极不成熟早产儿临床资料。结果该组早产儿的病死率为37.7%,导致死亡的独立危险因素为新生儿坏死性小肠结肠炎(NEC)和Ⅲ级以上脑室内出血(IVH)以及母亲患妊娠高血压综合征。存活病例在院需机械通气、鼻塞持续气道正压(NCPAP)、氧疗及住院时间分别为(30.8±38.5)d、(10.5±11.5)d、(84.0±46.7)d和(106.0±78.1)d,其中55.9%出院后需要继续家庭氧疗。呼吸窘迫综合征(RDS)、动脉导管未闭(PDA)、支气管肺发育不良(BPD)、IVH、早产儿视网膜病(ROP)、脑室周围白质软化(PVL)、NEC、院内血流感染(BSI)的发生率分别为85.5%、62.3%、74.2%、36.5%、71.1%、12.6%、12.6%和29.6%。结论极不成熟早产儿无严重并发症时可能存活,但病死率和并发症仍较高,尤其是胎龄不满25周的早产儿,故在对该类极不成熟早产儿实施救治时应进行个体化的综合评估。
Objective To analyze and evaluate the mortality, complications and risk factors of very immature premature infants less than 28 weeks gestational age, and provide reference for the clinical decision-making of such premature infants. Methods A retrospective analysis was performed on 219 cases of very immature premature infants admitted to NICU from January 2005 to August 2007 at Washington University Children’s Hospital in St. Louis. Results The mortality of preterm infants in this group was 37.7%. The independent risk factors of death were neonatal necrotizing enterocolitis (NEC) and grade Ⅲ or higher intracerebral haemorrhage (IVH) and maternal pregnancy induced hypertension syndrome. Survival cases were hospital ventilated, continuous positive airway pressure (NCPAP), oxygen therapy and hospital stay were (30.8 ± 38.5) d, (10.5 ± 11.5) d, (84.0 ± 46.7) d and ) d, of which 55.9% need to continue home oxygen therapy after discharge. Respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), bronchopulmonary dysplasia (BPD), IVH, retinopathy of prematurity (ROP), periventricular leukomalacia (PVL), NEC, ) Were 85.5%, 62.3%, 74.2%, 36.5%, 71.1%, 12.6%, 12.6% and 29.6%, respectively. Conclusion Very immature premature children may survive without serious complications, but mortality and complications are still high, especially in premature children less than 25 weeks gestational age, so in the treatment of such extremely immature premature children should be carried out Individualized comprehensive assessment.