The Analyze Of Relationship Between The Laboratory Tests And Critical Levels As Well As Prognoses Of 248 Newborns In NICU

Objective: To summarize the laboratory tests of newborns in NICU and analyze the relationship between them and critical levels as well as the prognoses,providing the laboratorial evidence for measuring the state of the patients and predicting the prognosis.Methods: The complete cases of 248 newborns in NICU of children's hospital of chongqing medical university from August to December in 2007 were reviewed, regarding the general conditions and the laboratory tests including blood routine test, blood sugar, electrolyte and blood gas analysis. To investigate the laboratory tests among different critical levels and among different prognoses.Results:(1)Of the total 248 cases of newborns in NICU, the sex ratio of male to female was 2.4:1.Early newborn accounted for 91.1%.Preterm infant and full term infant were 61.3% and 38.7% separately.The average birth weight was 2372.40±743.29 g; and the percents of ELBW, VLBW, LBW, NBW and macrosomia were 0.8%,9.3%,46.0%,42.3% and 1.6% respectively. (2)Of all the patients,86.3% of patients'main diagnosis were pneumonia and NRDS. The cure group, the better group and the death or give up group were 48.8%,45.6% and 5.6% respectively. The percent of patients whose hospitalization within 14 days was 66.1%. According to the neonatal critical illness score, the cases of extremely critical group, critical group and noncritical group were 4(1.6%),168(67.7%) and 76(30.6%) respectively.(3) Of the patients younger than 3 days, the percents of increased WBC, normal WBC and decreased WBC were 1.0%,82.7% and 16.3% respectively; while of those older than 3 days, the percents were 5.0%, 85.0% and 10.0% respectively.Neutrophilic granulocytopenia in full term infant was 26.0% (25/96), while in preterm infant the percent was 17.1%(26/152).(4)Of all the patients, the average value of pH was 7.19±0.12, and the percent of decreased pH was 71.4%.The value of blood lactate fluctuated between 0.7mmol/L and 15mmol/L, and the value less than 2 mmol/L accounted for 7.3%, between 2 mmol/L and 5 mmol/L accounted for 51.6%, and more than 5 mmol/L accounted for 41.1%; and among all the patients lactic acidosis occupied 33.1%. The value of HCO₃^- fluctuated between 3 mmol/L and 49.5 mmol/L, the patients with decreased HCO₃^- occupided 79.1%.(5)Except the laboratory tests including in neonatal critical illness score, the values of WBC, ANC, blood lactate and HCO₃^- had statistical significance among different critical level groups(P<0.05). And the more serious the patient was, the higher level of WBC, ANC and blood lactate were, and the lower level of HCO₃^- was.(6)Of all the laboratory tests, the values of blood lactate and pH had statistical significance among different prognostic groups(P<0.05). The level of pH was lowest in the death or give up group and was highest in the better group. While the level of blood lactate was highest in the death or give up group and was lowest in the cure group.Conclusions:(1)The newborns in NICU were mainly early, preterm and low birth weight newborns, and pathogen was mainly respiratory disease.(2)Most of the newborns in NICU had different degrees of blood gas derangement including decreased pH and HCO₃^- as well as increased blood lactate or lactic acidosis.(3)The values of blood lactate among different critical groups had statistical significance, the more serious the patient was, the higher level of blood lactate was.(4)The values of blood lactate among different prognostic groups had statistical significance too. The worse the prognosis was, the higher level of blood lactate was.So the level of blood lactate could be used as a simple and sensitive marker in early diagnosis of neonatal critical illness,and also be helpful for predicting the prognosis.And it was hopeful to be another quantification marker to measure the state of neonatal illness in NCIS system.