Analysis Of The Risk Factors And Complications Of Hospitalized Preterm Infants

ObjectiveIn recent years, the incidence of preterm infants has increased gradually, and because of the development of Perinatal Medicine, the use of pulmonary surfactant and intravenous nutrition, the survival rate of preterm infants has notably increased. But a series of complications and sequelae of all systems come to be the main problem which puzzled every pediatric doctor. This subject is to understand the constituent ratio of preterm infants, risk factors of preterm birth, common complications of preterm infants and prognosis relevant factors by analyzing the clinical data of preterm infants hospitalized in our hospital retrospectively, in order to provide epidemic evidence for reducing the incidence of preturm birth and improving quality of life of preturm infants.MethodsQuestionaire of preterm infant hospitalized in NICU of Shandong provincial hospital was designed. The clinical data of preterm infants hospitalized in NICU of Shandong provincial hospital from January of 2008 to June of 2010 were collected to analyze the complication and risk factors of preterm birth. All the data were analyzed by SPSS 17.0, P<0.05 means having statistic significance.Results746 cases of preterm infants were admitted into our NICU from January of 2008 to June of 2010(323 cases in 2008,225 cases in 2009,198 cases in 2010), accounting for 31.34% of neonates of the same term.68 cases were excluded for incomplete data. Specific circumstance as follows.1. Among the 678 cases of preterm infants,29 cases(4.28%) of them were born at gestational age less than 28 weeks; 64 cases(9.44%) were born at gestational age of 28 to 30 weeks; 152 cases(22.42%) were born at gestational age of 30-32 weeks; 244 cases(35.99%) were born at gestational age of 32-34 weeks; 189 cases(27.88%) were born at gestational age of 34-36 weeks. The average gestational age was 32.98±2.22 weeks.2. Among the 678 cases of preterm infants, birth weight of 14 cases(2.07%) was below 1000g, birth weight of 123 cases(18.14%) was between 1000g to 1500g, birth weight of 205 cases(30.24%) was between 1500g to 2000g, birth weight of 230 cases(33.92%) was between 2000g to 2500g, birth weight of 106 cases(15.63%) was above 2500g. The average birth weight was 1996±560g (600g-401 Og)3.The age of their mothers differed from 20-year-old to 47-year-old. The most common maternal diseases were hypertension syndrome of pregnancy(37.76%), uterus abnormality(8.41%), gestational diabetes(5.16%).4. Fetal factors of preterm birth mainly included:preterm rupture of membrance 207 cases(30.53%), multiple births 201 cases(29.65%), fetal distress 125 cases(18.44%).5. The incidences of umbilical cord, amniotic fluid and placenta abnormality were 16.96%,14.31%,8.85%, respectively.6. Among all preterm infants in this study,204 cases(30.09%) had Apgar score less than 8 points in 1st minute after birth,107 cases (15.78%) had Apgar score less than 8 points in 5th minute after birth,69 cases (10.18%) had Apgar score less than 8 points in 10th minute after birth.7. Among all the 678 cases of preterm infants,10 cases(1.47%) had MODS,8 cases(1.18%) had DIC,51 cases(7.52%) were given up,29 cases (4.28%)died. The main complications successively were:HIE(56.05%), neonatal pneumonia(46.61%), NRDS(33.63%), asphyxia neonatorum(29.50%), electrolyte disturbance(22.27%), apnea(20.50%), hyperbilirubinemia(19.47%), anemia(17.55%), feeding intolerance(14.75%), congenital abnormal development 11.80%), transient hypothyroidism(11.21%), organ damage(9.44%), septemia(6.93%), abnormal glucose metabolism(5.90%), scleredema(5.90%). NRDS, asphyxia neonatorum, apnea, neonatal pneumonia, pulmonary hemorrhage, BPD, HIE, ICH, feeding intolerance, anemia and transient hypothyroidism had negative correlation with birth weight and gestational age (P all<0.01).In addition, septemia, scleredema and congenital abnormal development had negative correlation with gestational age (P<0.05). NRDS, neonatal pneumonia, asphyxia neonatorum, feeding intolerance, pulmonary hemorrhage, ICH, cardiac failure and respiratory failure had negative correlation with prognosis (P all<0.001). Fetal distress and transient hypothyroidism also had negative correlation with prognosis (P<0.05)8. Both birth weight and gestational age had negative correlation with hospital stays and prognosis (P all<0.001)Conclusion1. The constituent ratio of preterm infants in hospitalized neonates is on the rise.2. Many factors could lead to preterm birth. Hypertension syndrome of pregnancy, uterus abnormality and gestational diabetes were the most common maternal factors. Preterm rupture of membrance, multiple birth and fetal distress were the main fetal factors. Contaminate amniotic fluid, cord around neck. placental presentation placental abruption were the most common amniotic fluid, umbilical cord and placenta factors.3.The main complications of preturm infants included HIE, NRDS, asphyxia neonatorum, neonatal pneumonia, apnea, hyperbilirubinemia, anemia, feeding intolerance, electrolyte disturbance and transient hypothyroidism.4. NRDS, neonatal pneumonia, asphyxia neonatorum, feeding intolerance, pulmonary hemorrhage, ICH, cardiac failure, respiratory failure, fetal distress and transient hypothyroidism are related with prognosis.5. Birth weight and gestational age had notable correlation with bad prognosis, indicating that strengthening antenatal examination and pregnancy education, reducing the incidence of preterm birth are of great importance.