Complications And Prognosis Of Extremely Low Birth Weight Infants

Objective:This thesis focused on analyzing the survival rate and hospital complications of extremely low birth weight infants(ELBWI)treated in the neonatal intensive care unit of Suzhou Mother and Child Hospital.Based on the analysis,high-risk factors that affecting the prognosis were investigated in this thesis.The purpose was to provide relevant clinical evidence in terms of improving the treatment level as well as reducing complications of extremely low birth weight infants.Methods:The data of hospitalization of extremely low birth weight infants,who were admitted to the neonatal intensive care unit from January 2015 to December 2019,were collected by applying to the electronic medical record system of Suzhou Mother and Child Hospital.The clinical data of the pregnant mothers’ past motherhood history.perinatal factors,and the general situation,complications,treatment and outcome of the infants at birth were mainly recorded.The thesis adopted retrospective research method,established an excel database,and then imported SPSS 25.0 software for related data analysis.The data were analyzed by using t test,rank su1 test,χ2 test,χ2 trend test,logistic regression analysis and other test methods.Results:1.Basic situation:In the past five years,118 ELBWI had been treated,of which 95 infants met the inclusion criteria.There were 43 male babies and 52 female babies,with a ratio of 1:1.2.There were 59 cases of singletons and 36 cases of twins.There were 58 cases of vaginal delivery and 37 cases of cesarean section.95 infants had a gestational age ranging from 23 to 32+6 weeks,with an average gestational age of(27.57±2.26)weeks;and a birth weight ranging from 490 to 980g,with an average birth weight of(83 7.68±109.28)g.Of the 95 infants,65 were alive and 30 were dead.The average gestational age of the survival group was(28.09±2.14)weeks,and the average birth weight was(867.85±94.32)g.The average gestational age in the death group was(26.43±2.12)weeks,and the average birth weight was(772.33±112.33)g.2.Main situation of perinatal period:There were 53 cases(55.79%)of pregnant mothers who had a bad history of pregnancy and childbirth,28 cases(29.47%)using assisted reproductive technology,25 cases(26.32%)with hypertension during pregnancy,and 21 cases(22.11%)with premature rupture of membranes(≥24h).There were 50(53.68%)cases of using prenatal hormones and 28(29.47%)cases of intubation in the operating room or delivery room.3.Survival rate:65 infants of the 95 infants(who survived to discharge from the hospital were included)and the survival rate was 68.42%.The survival rate of ELBWI was increasing year by year from 2015 to 2019,and the difference was statistically significant(P<0.05).At the same time,it also showed an increasing trend with the increase of gestational age and birth weight,and the difference was statistically significant(P<0.05).4.Incidence of major complications:The main complications and incidence of ELBWI were neonatal respiratory distress syndrome(82.11%),bronchial pulmonary dysplasia(47.37%),septicemia(41.05%),retinopathy of prematurity(40.00%),patent ductus arteriosus(38.95%),intracranial hemorrhage(28.42%),parenteral nutrition-associated cholestasis(22.11%),apnea(21.05%),necrotizing enterocolitis(stageⅡ/Ⅲ)(15.79%),pulmonary hemorrhage(15.79%),ventilator associated pneumonia(15.79%).5.Complications and treatments of surviving infants:The surviving ELBWI was divided into two groups,namely the 2015～2017 group and the 2018～2019 group,and the occurrences and treatments of complications between the two groups were compared.The incidence of retinopathy of prematurity in the 2018～2019 group was lower than that in the 2015～2017 group,and the differences were statistically significant(P<0.05).The use of pulmonary surfactant and prophylactic caffeine in the 2018～2019 group was higher than that in the 2015～2017 group,and the differences were statistically significant(P<0.05)6.Prognostic factors:The perinatal factors and complications of infants were compared between the survival group and the death group.The results showed that the average gestational age and average birth weight of ELBWI in the survival group were greater than those in the death group,and the differences were statistically significant(P<0.05).The proportions of hypertension,cesarean section,and prenatal hormones in the survival group were higher than those in the death group,and the differences were statistically significant(P<0.05).The proportion of twins,1min Apgar score 0～7,and intubation in the delivery room were lower in the survival group than in the death group,and the differences were statistically significant(P<0.05).The incidence of pulmonary hemorrhage in the survival group was lower than that in the death group,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis was performed on the univariate factors with statistical significance among the above groups(P<0.05).The results showed that gestational age<28 weeks(OR=7.792,95%CI 1.535～39.551,P=0.013),birth weight<800g(OR=10.132,95%CI 2.297～44.695,P=0.002),twins(OR=4.046,95%CI 1.081～15.143,P=0.038),and pulmonary hemorrhage(OR=9.006,95%CI 1.586～51.151,P=0.013)were independent risk factors affecting the prognosis of extremely low birth weight infantsConclusion:1.The survival rate of ELBWI was increasing year by year,and its survival rate was increasing with the increase of gestational age and birth weight.2.ELBWI had many severe complications and sequelae,which needed complex treatments and long hospital stay with a low survival rate.The use of pulmonary surfactant and preventive caffeine could reduce the incidence of complications in infants.3.The prognosis of ELBWI was affected by many factors,including gestational age<28 weeks,birth weight<800g,twins,and among them pulmonary hemorrhage were independent risk factors affecting the prognosis of ELBWI.