The Morbidity and Survival of Very-Low-Birth-Weight Infants in Taiwan

台灣地區極低出生體重兒之罹病及短期預後

鄒國英(Kuo-Inn Tsou) ； 曹伯年(Po-Nien Tsao) ； 台灣早産兒聯合追蹤小組(Taiwan Infant Development Collaborative Study Group)

《Acta Paediatrica Taiwanica》 44卷6期 (2003/12) Pp. 349-355

https://doi.org/10.7097/APT.200312.0349

摘要

週産期及新生兒醫療水凖之進步，在許多地區的極低出生體重兒（出生體重≦1500公克）之存活率，在近年均有顯著的進步。爲瞭解台灣極低出生體重兒的罹病、存活極率與導致死亡相關之因素，本文會對民國八十五年一月一日至同年十二月三十一日，出生七天內住入參與早産兒追蹤門診專案醫院的極低出生體重兒，分析他們的同産期及住院資料。台灣北中南三區共有十二傢俱levelⅡ(上標 +)或Ⅲ新生兒加護病房的醫院參與，在此一期間共登錄613例（男嬰292例，女嬰301例）合於收案條件之個案資料，北區爲305例，中區爲181例，南區爲127例。平均出生體重爲1133±272(368-1500)公克，平均妊娠週數爲28.9±3.0(21-38)週。25.8%爲體重不足兒，90.2%的個案爲具高危妊娠因素之孕婦所生，55.0%爲經由開刀生産娩出，68.1%的嬰兒於出生後需接受甦醒球按壓、氣管插管或心肺急救。52.9%於出生前母親有使用類固醇促進胎兒肺部成熟，然而接受二劑或二劑以上類固醇藥物的胎兒不到20%。33.3%的嬰兒是經由産前轉診的産婦所生，22.7%的嬰兒是於出生後經由新生兒轉診至受照顧醫院。最常見的疾病爲呼吸暫停(66.1%)，其次爲呼吸窘迫症候群(60.0%)。發生慢性肺疾病的有76例(16.5%)。此613例極低出生體重兒之仔活率爲76.2%，出生體重≦1000公克的仔活率爲49.2%，1001~1500公克的仔活率爲88.5%。懷孕週數≦26週的仔活率爲35.3%，27-36週的仔活率爲87.5%。出生週數小於23週的沒有嬰兒仔活，出生體重601公克的沒有嬰兒仔佸。最常見的死亡原因爲敗血症，其次爲極度早産（妊娠週數≦23）及呼吸窘迫症候群。多變項迴歸分析結果，顯示和極低出生體重兒死亡相關之因素爲懷孕週數≦26週、出生體重≦800公克、出生時需急救及併發氣胸。結論：台灣極低出生體重兒的仔活率，在近20年雖有逐漸提昇，但和其他地區或國家的統計資料相比較時，仍爲較低，對超低出生體重早産兒，週産期及新生兒期醫療照顧的提昇、新生兒急救訓練的加強，均是我們需努力的部分。

關鍵字

極低出生體重兒 ； 罹病率 ； 存活率 ； 産房內急救

並列摘要

Advances in obstetrical and neonatal care have increased the survival of very-low-birth-weight (VLBW) infants, defined as infants weighing ≤1,500g at birth, in many populations. To understand the morbidity and survival of VLBW infants in Taiwan, the records of all VLBW admitted to the 12 hospitals with a level II(superscript +) or level III neonatal intensive care unit (NICU), at＜7 days of age, from January 1 to December 31, 1996, were collected prospectively. A total of 613 VLBW infants (292 males and 301 females) met the enrollment criteria: 305 cases from the northern region, 181 cases from the central region, and 127 cases from the southern region of Taiwan. The mean birth weight was 1,133g (range, 368-1,500); the mean gestational age (GA) was 28.9 weeks (range, 21-38). Among the VLBW infants, 25.8% were small-for-gestational-age, 90.2% were born to mothers with high-risk factor(s) for preterm delivery, 55% were born by cesarean section, and 68.1% required resuscitation at birth. The percentage of prenatal use of steroids was 52.9%, and ＜20% received more than one dose of antenatal steroids. Thirty-three percent were born after antenatal maternal transfer, and the neonatal transfer rate was 23%. The most common neonatal complication was apnea of prematurity (66.1%), followed by respiratory distress syndrome (RDS) (60%). Chronic lung disease occurred in 76 cases (16.5%). The overall survival rate of the 613 VLBW infants was 76.2%; for infants weighing ≤1000g at birth, it was 49.2%, and for infants weighing., 001-1,500g at birth, it was 88.5%. The survival rate for infants with a GA≤26 weeks was 35.3%, and for infants with a GA of 27-36 weeks was 87.5%. No infant with a birth weight ≤600g or a GA≤23 weeks survived. The most common cause of death was sepsis, followed by extreme prematurity (GA≤23 wks) and RDS. Several perinatal and neonatal factors were related to the mortality. Multiple regression analysis of survival showed that GA≤26 weeks, birth weight ≤800g, delivery room resuscitation and the occurrence of pneumothorax were related to mortality. Therefore, although the survival rate of VLBW infants admitted to level II(superscript +)-III NICUs showed an improvement over the rate for the previous 20 years in Taiwan, perinatal and neonatal care of extremely preterm infants and neonatal resuscitation programs need to be emphasized to improve the outcome of VLBW infants furthermore.

並列關鍵字

very-low-birth weight ； morbidity ； survival rate ； delivery room resuscitation