Outcome for Very Low Birth-Weight Infants

自民國73年1月至75年12月，共有73個出生體重小於1501公克的早産兒在榮民總醫院誕生，佔總活産人數的千分之7.5，男女比例爲34:39，扣除4個自動出院的個案，本研究共有69個病例。出生體重小於1001公克的早産兒，其住院期間死亡率爲65%，1001-1500公克的爲30.6%，總住院死亡率爲40.6%。41個活存的早産兒中除掉一個自動出院後即失去連繋外，其餘的均在早産兒門診繼續追蹤，除少數幾個案因爲合作上的困難，大部分的個案均做過一次以上的發育評估，其最後一次評估的年齡扣掉早産的週數所得結果爲8個月至4歲。5個個案(12.5%)有嚴重的殘障，他們或有明顯的發育遲緩，或有足以影響日常生活的缺陷或疾病，譬如耳聾、早産兒視網膜病變引起的弱視等。其中一個個案在出生後18個月因爲腦室引流管阻塞死亡；6個個案(15.0%)有中等程度的障礙；其餘29個病例(72.5%)被歸類爲正常或只有暫時性輕微的問題。本報告中將死亡及有嚴重殘障的病例歸屬於“預後不好”的一羣，其餘的歸屬“預後較好”的一羣，再以逐步區別分析統計法(Stepwise multiple discriminant function analysis)顯示出4個輿預後有關的因素，它們依重要性排列分別爲肺部出血、出生體重、顱內出血、母親産前出血。其中較重的出生體重對預後有好的影響，其餘3種情況的存在對預後有不良影響，即較有可能死亡或雖存活卻有嚴重的殘障。在本研究中以此預測預後，其正確率可達85.1%。長期追蹤以至於學齡時期是評估生存者真正生活品質的唯一方法，因爲有多篇的報告指出極低體重早産兒長大後往往有學習上的障礙，所以除了致力於存活率的提高外此將是日後工作的目標。早産兒的存活率及殘障率各個中心均有不同的統計資料，由於客顴條件及研究方法的不同，這一類資料很難做到真正的比較，因此每個中心必須有自己的統計，特別是在輿父母親商討預後及決定治療方向時，此乃本研究的主要目標輿動機。

關鍵字

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並列摘要

A total of 69 very low birth weight ( VLBW=birth weight≤1500gm) infants, born at Veterans General Hospital from January 1, 1984 until December 31, 1986, were studied, excluding 4 patients who were discharged before the condition was stabilized and were also lost to follow-up. The incidence of VLBW infants was 7.5 per thousand of 9214 total live birth deliveries; male to female ratio was 34:39. The hospital mortality rate for babies with birth weight less than 1001gm was 65%; for those with birth weight 1001-1500gm was 30.6%; the total mortality at hospital discharge was 40.6%. The corrected ages at final follow-up assessment ranged from eight months to four years. Among the 41 survivors one case was lost to follow-up. Of the remaining 40 cases, 5 cases had major handicap which was manifested with either severe debilitating morbidity or marked developmental delay; the incidence was 12.5%. One of them died at the postnatal age of 18 months due to ventriculoperitoneal shunt (V-P shunt) obstruction. Six cases (15.0%) had moderate handicap; the remaining 29 cases (72.5%) were considerd to be normal or to suffer from transient, mild, resolvable problems. Cases with mortality or major handicap were categorized into ”worse” group. otherwise they belonged to the ”better” group. Stepwise multiple discriminant function analysis showed that four factors could correctly classify the outcome in 85.1% of infants: pulmonary hemorrhage was the most important factor followed by birth weight, intraventricular hemorrhage, and maternal antepartum hemorrhage. Greater birth weight was associated with better outcome while the presence of the other three conditions were associated with higher mortality and higher possiblilty of survival with major handicap.

並列關鍵字

very low birth weight infants ； outcome ； stepwise multiple discriminant function analysis

國際替代計量

Outcome for Very Low Birth-Weight Infants

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