Abstract:

Objective　To analyze the mortality ， morbidity and a variety of perinatal and neonatal factors of extremely premature infants

with gestational age of < 28 weeks.  Methods　The clinical charts of 219 infants with gestational age of < 28 weeks cared in NICU of St

Louise Children’s Hospital in USA were reviewed and the data were analyzed retrospectively with SPSS software. Results　The mortality was

37.7% and NEC， grade 3 or 4 IVH and PIH were independent risk factors for death. For survivors， the mean length of hospital stay was

（106.0±78.1） days； the duration of mechanical ventilation， nasal continuous positive airway pressure and oxygen administration， was

（30.8±38.5）days， （10.5±11.5）days and （84.0±46.7）days， respectively. The incidences of RDS，PDA，BPD，IVH，ROP，PVL，NEC and BSI

were 85.5%、62.3%、74.2%、36.5%、71.1%、12.6%、12.6% and 29.6%， respectively， with 55.9% infants discharging home on oxygen. Conclusion　

Survival without disability is possible， but the morbidities are still high in extremely premature infant with gestational age of < 28

weeks. Individualized discussions and approaches to this group of infants are suggested.

Key words: infant, extremely premature；mortality；NEC；IVH；PIH

摘要：

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。

关键词: 早产儿, 极不成熟；小肠结肠炎；脑室内出血；妊娠高血压综合征