| Objective:Domestic and foreign reported very low birth weight children (VLBW) incidence increased yearly. Due to the development of perinatal medicine and pediatrics, more and more children were able to survive in very low birth weight. However, due to low birth weight, small for gestational age, possible complications, and long hospitalization, very low birth weight children have become the main focus of patient management in neonatal intensive care unit (NICU). Hence, the capability treatment of very low birth weight children has become one of the key aspects of neonatal department’s developmental evaluation. In recent 10 years, the spectrum of diseases, diagnosis, treatment and care in very low birth weight children had undergone rapidly significantly change. Neonatologists needed to promptly keep updated with every change in very low birth weight children.Furthermore, changes in disease spectrum had been asking for new demands on neonatal doctors’treatment concepts and methods. With the increasing case in number of very low birth weight children, continuous positive airway pressure (CPAP), mechanical ventilation and parenteral nutrition therapy techniques had been widespread applied. Moreover, clinical problems in oxygen dependency, necrotizing enterocolitis, retinopathy of premature children and cholestasis psychosis had become increasingly prominent, and yet, many medical personnel were unaware the serious issues. Therefore, it is urgent to analysis and summarized the issues in very low birth weight children in order to guide clinical decision-making in better treatment and service for the little patient.Methods:(1) Clinical form of very low and extremely low birth weight infants was designed. (2) A standardized neonatal clinical database was construted to collect the information from clinical forms. (3) Date collection:These 1658 very low and extremely low birth weight infants who were admitted to the Division of Neonatology from 2001.1.1 to 2012.12.31 were enrolled in the study. We summarize the data about basic personal information, maternal history, discharge diagnosis, treatment and prognosis. (4) Analysis:A retrospective research was made in this database. Statistical analyses were performed in this database.Results:(1) Basic characteristics:In 1658 case of infants, of which 249 cases of extremely low birth weight infants, there were 944 male infants and 714 female, male to female ratio of 1.3:1.The mean gestational age was 29.7±2.4wk, the mean birth weigh was 1217.2±197.1g. (2) Maternal history:IVF ratio of 7.1%(n=117).2.4% (n=1024) mothers of newborns had regular prenatal care. The incidence of multiple births was 24.6%(n=408), twins accounted for 22.1%(n=366).Pregnancy induced hypertension, intrauterine infections and gestational diabetics, hepatitis B and cholestasis were the most common diseases during pregnancy.7.6%(n=126) in very low birth weight children in distress. (3) Disease spectrum: Hyperbilirubinemia(66.0%,n=1094),RDS(46.4%,n=769),PFO(45.8%,n=760), anemia(43.5%,n=721), PDA(36.7%,n=608) were the five incidence of neonatal diseases. Increasing number of very low and extremely low birth weight infants,RDS, PDA,NEC,ROP and related diseases are increasing these years. (4) Treatment:The mean duration in NICU was 21.5±23.2 days.59.9%(n=993) was given oxygen, 41.3%(n=684) were admitted with CPAP and 33.2%(n=550) with ventilator. 93.1%(n=1544) was given parenteral nutrition, the parenteral nutrition average number of days 17.8±2.4 days. (5) The mean duration of hospitalization was 43.3±37.0 days. (6) The infants who discharged with doctor’s approval accounted for 77.9%, given up for 10.4% and died for 11.7%. Healing rate increased year by year, and was associated to higher birth weight and gestational age. (7) The mean cost of hospitalization 37711.7±45256.4.Conclusions:(1) The proportion of very low and extremely low birth weight infants increased these years. (2) Hyperbilirubinemia, RDS, PFO, anemia, PDA were the five highest incidence of neonatal diseases. The disease spectrum of VLBW and ELBW infants became more widely in these 12 years, although RDS, hyperbilirubinemia still stayed an important role, NEC, PDA, anemia, ROP, BPD increased year by year, and substantially affects the very low birth weight infants prognosis. (3) Gestational age and birth weight are highly associated with the length of stay, hospital costs, treatment and prognosis. (4) The infants who discharged with doctor’s approval accounted for 77.9% and died for 11.7%. |
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