Analysis Of Clinical Epidemiology And Prognostic Factors In Extremely Premature Infants

Objective:Analysis of basic characteristics, complications during hospitalization, outcome and the factors that influence the outcome in extremely premature infants, in order to provide information for clinical treatment of extremely premature infants and evaluate the level of treatment in our hospital.Methods:We performed a retrospective analysis of 164 extremely premature infants(gestational age less than 28 weeks)in the First Hospital of Jilin University from2010 to 2015 by designing case questionnaire. According to the questionnaire we looked up medical records and summarized the basic information of infant, mother during pregnancy and perinatal information, complications during hospitalization and outcome. All datas collected using the software of Excel to establish a database. 27 cases gave up treatment due to parents’ personal reasons were excluded. The remaining 137 infants were divided into survival group and death / abandon group based on the clinical outcome. Using SPSS17.0 statistical software for analysis of univariate analysis and multivariate logistic regression analysis, to screen the risk factors that influence the prognosis of extremely premature infants.Result:1. A total of 164 cases of extremely premature infants meet the inclusion criteria,88 cases male, 76 cases female, male to female ratio was 1.2:1. The gestational age ranged from 24 weeks to 276/7 weeks, mean gestational age was(26.8±0.9) weeks;birth weight ranged from 500 grams to 1600 grams, mean birth weight was(1019.0±203.4)g.2. From 2010 to 2015, the number of extremely premature infants were 12 cases,22 cases, 21 cases, 24 cases, 45 cases, 40 cases respectively; with percentage of0.33%、0.55%、0.48%、0.57%、1.12%、1.07% in the total number of the same period;with percentage of 1.06%、1.65%、1.41%、1.51%、2.75%、3.22% in the preterm of the same period, showed an increasing trend basically. The extremely premature infants were 55 cases from 2010 to 2012, while were 109 cases from 2013 to 2015.Compared with the first 3 years, the number of extremely premature infants were significantly increased(P<0.05).3. The number of extremely premature infants in gestational age less than 25 weeks, 25 weeks~, 26 weeks~, 27 weeks~ groups were 5 cases(3.0%), 17 cases(10.4%), 48 cases(29.3%), 94 cases(57.3%), mainly ranged from 26 weeks to 276/7weeks; the number of extremely premature infants in birth weight less than 750 g,750g~, 1000g~, 1250g~ groups were 15 cases(9.1%), 56 cases(34.1%), 70 cases(42.7%), 23 cases(14.0%), mainly ranged from 750 g to 1249 g.4. The incidence of common complications: bronchopulmonary dysplasia 69cases(83.1%); neonatal respiratory distress syndrome 105 cases(73.4%); retinopathy of prematurity 49 cases(61.3%); hemodynamic significant patent ductus arteriosus 83cases(58.0%); intraventricular hemorrhage 72 cases(50.3%); sepsis 55 cases(38.5%);pulmonary hemorrhage 20 cases(14.0%); necrotizing enterocolitis 14 cases(9.8%).5. The total survival rate of extremely premature infants was 42.7%. In 2010~2015, the survival rates were respectively 16.7%, 27.3%, 23.8%, 41.7%, 53.3%,57.5%, showed an increasing trend year by year basically. The survival rate in 2010~2012 was 23.6%, while was 52.3% in 2013~2015. Compared with the first 3 years,the survival rate of extremely premature infants was significantly increased(P<0.05).The survival rates in gestational age less than 25 weeks, 25 weeks~, 26 weeks~, 27weeks~ groups were respectively 0%, 29.4%, 43.8%, 46.8%, in birth weight less than 750 g, 750g~, 1000g~, 1250g~ groups were respectively 6.7%, 35.7%, 48.6%,65.2%. With the increase of gestational age and birth weight, the survival rate of extremely premature infants was increasing.6. The total give up treatment rate of extremely premature infants was 35.4%. In2010 ~ 2015, the give up treatment rates were respectively 25.0%, 63.6%, 33.3%,37.5%, 22.2%, 37.5%. The give up treatment rate in 2010~2012 was 43.6%, while was 31.2% in 2013~2015. Compared with the first 3 years, the give up treatment rate of extremely premature infants was decreasing(P>0.05)。The give up treatment rates in gestational age less than 25 weeks, 25 weeks~, 26 weeks~, 27 weeks~ groups were respectively 60.0%, 41.2%, 33.3%, 34.0%, in birth weight less than 750 g,750g~, 1000g~, 1250g~ groups were respectively 46.7%, 42.9%, 30.0%, 26.1%.With the increase of gestational age and birth weight, the give up treatment rate of extremely premature infants was decreasing.7. Univariate analysis showed that there were statistical differences in gestational age, birth weight, Apgar 1~3 score, antenatal corticosteroid, shock, pulmonary hemorrhage, grade Ⅲ-Ⅳ intraventricular hemorrhage and scleredema between the two groups(P<0.05).8. Multivariate logistic regression analysis suggested pulmonary hemorrhage,grade Ⅲ-Ⅳ intraventricular hemorrhage and scleredema were independent risk factors for poor prognosis of extremely premature infant, and antenatal corticosteroid was protective factor for outcome(P<0.05).Conclusions:1. The number of hospitalized extremely premature infants in our hospital from2010 to 2015 had an increasing trend.2. The gestational age of hospitalized extremely premature infants mainly ranged from 26 weeks to 276/7 weeks, birth weight maily ranged from 750 g to 1249 g.3. The total survival rate of hospitalized extremely premature infants was 42.7%,which was positively related to gestational age and birthweight. Compared with the first 3 years, the survival rate was increasing.4. The give up treatment rate of hospitalized extremely premature infants was high, which was inversely related to gestational age and birthweight.5. The most common complications were bronchopulmonary dysplasia, neonatal respiratory distress syndrome, retinopathy of prematurity, patent ductus arteriosus,intraventricular hemorrhage and sepsis.6. Low gestational age, low birth weight, Apgar 1~3 score, not using antenatalcorticosteroid, shock, pulmonary hemorrhage, grade Ⅲ-Ⅳ intraventricular hemorrhage and scleredema were the risk factors of poor prognosis in extremely premature infants. Pulmonary hemorrhage, grade Ⅲ-Ⅳ intraventricular hemorrhage and scleredema were independent risk factors for poor prognosis of extremely premature infants, and antenatal corticosteroid was protective factor for outcome.