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目的探讨极低出生体重(VLBW)和超低出生体重(ELBW)婴儿母亲孕期危险因素、生后并发症、治疗及转归。方法采用回顾性分析法对2013年7月至2015年7月我院收治的VLBW/ELBW婴儿临床资料进行分析。结果共纳入VLBW/ELBW婴儿148例,其中胎龄<28周20例,28~31周89例,32~36周39例(包括小于胎龄儿28例);出生体重<1 000 g 16例,1 000~1 249 g 54例,1 250~1 499 g 78例。VLBW/ELBW婴儿母亲孕期危险因素前五位分别为:妊娠期高血压综合征58例(39.2%),双胎或多胎36例(24.3%),高龄孕妇(≥35岁)32例(21.6%),胎膜早破30例(20.3%),试管婴儿16例(10.8%);VLBW/ELBW婴儿最常见并发症为新生儿窒息(76例,51.4%)和新生儿呼吸窘迫综合征(RDS)(66例,44.6%)。体重<1 000 g组、胎龄<28周组RDS发生率明显高于其他组;胎龄28~31周组、体重1 000~1 249 g组新生儿肺炎发生率明显高于其他组;胎龄<28周组、体重1 000~1 249 g组呼吸暂停发生率明显高于其他组;体重1 000~1 249 g组贫血发生率明显高于其他组。148例患儿存活106例,死亡42例,病死率28.4%。ELBW婴儿存活率25.0%,VLBW婴儿存活率77.3%。引起死亡的主要原因为家属放弃治疗,其次为肺出血、RDS和重症感染。结论加强围产期保健、提高自然受孕率、积极预防和治疗各种并发症可以提高VLBW/ELBW婴儿存活率。
Objective To investigate the risk factors during pregnancy, postnatal complications, treatment and outcomes of mothers with very low birth weight (VLBW) and very low birth weight (ELBW) mothers. Methods The clinical data of VLBW / ELBW infants admitted to our hospital from July 2013 to July 2015 were analyzed retrospectively. Results A total of 148 VLBW / ELBW infants were enrolled. Among them, 20 were gestational age <28 weeks, 89 were 28-31 weeks, 39 cases were 32-36 weeks (including 28 children less than gestational age), 16 were born <1 000 g , 1 000 ~ 1 249 g 54 cases, 1 250 ~ 1 499 g 78 cases. The top five risk factors for pregnancy during VLBW / ELBW mothers were: 58 (39.2%) with gestational hypertension, 36 (24.3%) with twins or multiple births, 32 (21.6% ), Premature rupture of membranes (20.3%) and IVF in 16 (10.8%). The most common complications of VLBW / ELBW infants were neonatal asphyxia (76 cases, 51.4%) and neonatal respiratory distress syndrome ) (66 cases, 44.6%). The incidence of pneumonia in neonates with body weight <1 000 g and gestational age <28 weeks was significantly higher than that in other groups. The incidence of neonatal pneumonia was significantly higher in those with gestational age ranging from 28 weeks to 319 weeks The incidence of apnea in group <28 weeks of age and body weight of 1 000-1 249 g was significantly higher than that of other groups. The incidence of anemia in body weight of 1 000-1 249 g group was significantly higher than that of other groups. 148 cases of children survived in 106 cases, 42 patients died, the mortality rate of 28.4%. ELBW infant survival rate of 25.0%, VLBW infant survival rate of 77.3%. The main causes of death were family abandonment of treatment, followed by pulmonary hemorrhage, RDS and severe infections. Conclusions Strengthen the perinatal care, improve the rate of natural conception, and actively prevent and treat various complications can improve the survival rate of VLBW / ELBW infants.