Clinical Analysis Of 329 Extremely Low Birth Weight Infants

ObjectiveExtremely low birth weight（ELBW）infants indicate a live baby with a birth weight<1000 g.The organ function is extremely immature,complications and the mortality rate are high.With the development of perinatal medicine in China,the level of treatment for ELBW infants has increased significantly in recent years,but there is still a large gap compared with developed countries.In order to improve the survival rate and the prognosis of ELBW infants,329 ELBW infants admitted to the neonatology department of the Third Affiliated Hospital of Zhengzhou University from January 2011 to December 2017 were selected for general information and hospitalization.Common complications during hospitalization,outcomes and follow-up were retrospectively analyzed to investigate the causes and outcomes of ELBW infants and provide a reference for clinical prevention.Materials and MethodsWe retrospectively investigated the neonates born in our hospital from January2011 to December 2017 with a birth weight<1000g.Exclusion criteria:（1）basic information and perinatal data of children were unknown.（2）Low birth weight infants who were not admitted to the neonatology department of our hospital for the first time.We collected general information,high-risk factors during perinatal period and major complications during hospitalization about ELBW infants,and common causes of death in children who died from the case file room of our hospital.The physical and psychomotor development of surviving children was obtained through follow-up after discharge.The data were statistically analyzed by SPSS21 software.The measurement data conforming to the normal distribution was expressed by the mean±standard deviation（x±s）.The measurement data of the skewed distribution was expressed by the median（M）,and the t-test was used for the comparison between the continuous variables.The categorical variables were compared using theχ2 test,and the P<0.05 was statistically significant.Results1.General condition:In the 7 years,348 cases of ELBW infants were treated in the neonatology department of our hospital.The 329 cases were eligible for inclusion.The birth weight was 500-995g,the average birth weight was（857.19±98.01）g,and the gestational age was 22⁺⁵³4⁺⁵ weeks.The average gestational age was（28.47±1.96）weeks.Male/female is 1.12:1.The number of ELBW infants has increased year by year from 2011 to 2017,increased from 10 in2011 to 81 in 2017.2.Pregnant mother situation:329 ELBW infants were from 261 pregnant mothers,including gestational hypertension syndrome:172（65.9%）,poor pregnancy history:103（39.5%）,premature rupture of membranes:79（30.3%）,elderly pregnant women:57（21.8%）,abnormal amniotic fluid:56（21.5%）,abnormal placenta:38（11.6%）,gestational diabetes:26（7.9%）,HELLP syndrome:15（5.7%）,thyroid disease:21（8.0%）,cervical insufficiency or relaxation:9（3.4%）,cardiac insufficiency or heart failure:7（2.7%）.3.Birth situation:291（88.4%）were naturally conceived,58（17.6%）were assisted reproductive techniques,197（59.9%）were singleton,120（36.5%）were twins,and 12（3.6%）were multiple births,116 cases（35.3%）were vaginal delivery and 213 cases（64.7%）were cesarean section.1 minute Apgar score≤3 points have57 cases（17.3%）,4 to 7 points have 207 cases（62.9%）,8 to 10 points have 65 cases（19.8%）;5 minutes Apgar score≤3 points have 19 cases（5.8%）,4 to 7 points have184 cases（55.9%）,8 to 10 points have 126 cases（38.3%）.4.Main complications:The main complications in the study were neonatal respiratory distress syndrome（81.1%）,bronchopulmonary dysplasia（50.2%）,retinopathy of prematurity（45.9%）and grade III-IV intracranial hemorrhage（13.4%）,and so on.5.Survival rate:The survival rate of 198 survived ELBW infants included in the study was 75.9%,and the survival rate was positively correlated with birth gestational age and birth weight.The difference was statistically significant（χ2=14.310,25.092,P=0.014,<0.001）.6.Main causes of death:The main causes of death in ELBW infants were infection（septicemia,severe pneumonia）:18 cases（28.6%）,neonatal respiratory distress syndrome:11 cases（17.5%）,severe asphyxia:10 cases（15.9%）.The common causes of death in children with early death（≤7d）were neonatal respiratory distress syndrome,severe asphyxia,etc.;the common causes of death in late death（>7d）were infection（septicemia,severe pneumonia）.The common causes of death in the previous stage（2011-2014）were:neonatal respiratory distress syndrome,severe asphyxia,infection（septicemia,severe pneumonia）,etc.;the common causes of death in the latter stage（2015-2017）were:infection（Sepsis,severe pneumonia）,pulmonary hemorrhage,bronchopulmonary dysplasia,etc.,and the difference in the composition of neonatal respiratory distress syndrome and severe asphyxia between the two stages was statistically significant（χ2=4.317,5.448,P=0.038,0.020）,and the composition ratio of infection（septicemia,severe pneumonia）was not statistically significant（χ2=2.835,P=0.092）.7.Survival follow-up:In this study,146 patients were followed up,52 patients were lost to follow-up,and 3 patients died.The maximum age of follow-up was 7years and 3 months,and the minimum age was 5 months.There were 34 cases（23.8%）with mental disorders and 44 cases（30.8%）with dyskinesia.Combined with the complications of children,86 patients（60.1%）in the BPD group and 57 patients（39.9%）in the non-BPD group,and the differences in mental disorders and dyskinesia between the two groups were statistically significant（χ2=4.962,4.201,P=0.026,0.040）.Conclusions1.The hospitalization and survival rate of ELBW infants in our hospital areincreasing year by year.2.The main causes of death in ELBW infants are:infection（septicemia,severepneumonia）,neonatal respiratory distress syndrome,severe asphyxia,pulmonaryhemorrhage,bronchopulmonary dysplasia,etc.3.ELBW infants are prone to mental and motor disorders,and their incidence isrelated to BPD.