Risk Factors of Pulmonary Hemorrhage in Very-Low-Birth-Weight Infants: A Two-year Retrospective Study

極低出生體重早産兒肺出血之危險因子的探討：兩年回溯性之研究

林宗文(Tsung-Wen Lin) ； 蘇百弘(Bai-Horng Su) ； 林鴻志(Hung-Chih Lin) ； 胡博翔(Paul-Shiang Hu) ； 彭慶添(Ching-Tien Peng) ； 蔡長海(Chang-Hai Tsai) ； 梁文敏(Wen-Miin Liang)

《Acta Paediatrica Taiwanica》 41卷5期 (2000/10) Pp. 255-258

https://doi.org/10.7097/APT.200010.0255

摘要

肺出血在極低出生體重早産兒併呼吸窘迫症候群是一嚴重之併發症。本研究之目的爲回溯性分析極低出生體重早産兒併發肺出血的盛行率和相關危險因子。研究對象爲自1997年1月1日至1998年12月321日止，隹進本院新生兒科加護病房之極低出生體重早産兒。大量肺出血的定義爲活動性氣管內管內出血，血容積下降超過百分之十及胸部X光檢查有多葉性浸潤現象。符合上述定義之病嬰計有20位，平均懷孕週數爲26.9±2.5週，平均出生體重爲909±209公克。研究期間內，我們隨意選取20位與研究對象之懷孕週數及出生體重相仿的病嬰作爲對照組。我們的研究顯示極低出生體重早産兒大量肺出血之盛行率爲5.9%(20/340)。急性期（出生後7天內）重要的危險因子包括産前末使用corticosteroid，早産兒呼吸窘迫症假群使用人工表面張力素，和開放性動脈導管合併心臓衰竭須強心劑支持者。爲了避免急性期大量肺出血及降低死亡率和罹病率，對無法避免早産之母親給予corticosteroid，仔細評估人工表面張力素的須要性，及早期診斷和積極治療具有血行動力變化的開放性動脈導管是有必要的。

關鍵字

肺出血 ； 極低出生體重早産兒 ； 人工表面張力素 ； 開放性動脈導管

並列摘要

Pulmonary hemorrhage is a serious complication in very-low-birth-weight (VLBW) infants with respiratory distress syndrome (RDS). We undertook a 2-year retrospective study to investigate the predisposing factors and the incidence of pulmonary hemorrhage in VLBW infants. From January 1997 through December 1998, twenty infants were diagnosed with massive pulmonary hemorrhage (MPH) according to the following criteria: active bleeding from the endotracheal tube, acute drop in hematocrit (≧10%), and the development of multilobar infiltration on chest radiograph. The mean gestational age was 26.9±2.5 weeks, the mean birth weight was 909±290g. Twenty historic controls with similar gestational age and birth weight were retrospectively identified during the study period. The incidence of MPH in VLBW infants was 5.9%(201340). A lack of prenatal corticosteroid administration, surfactant replacement therapy for RDS, and a patent ductus arteriosus (PDA) with cardiovascular dysfunction requiring dopamine support were the significantly predisposing factors of MPH in the acute stage(≦7th day of life). To avoid MPH and decrease mortality and morbidity in the acute stage, prenatal corticosteroid administration, evaluation of the necessity of surfactant therapy, and early recognition and aggressive treatment of hemodynamically significant PDA were necessary.

並列關鍵字

pulmonary hemorrhage ； very-low-birth-weight infants ； patent ductus arteriosus