Prognostic Predictors of Neurodevelopmental Outcome or Mortality in Very-Low-Birth-Weight Infants

極低出生體重嬰兒神經發展及死亡之預後因子

陳佩琪(Pei-Chyi Chen) ； 王培瑋(Pei-Wei Wang) ； 方麗容(Li-Jung Fang)

《Acta Paediatrica Taiwanica》 46卷4期 (2005/08) Pp. 196-200

https://doi.org/10.7097/APT.200508.0196

摘要

近年來，由於週產期醫學的進步，使得體重小於1500公克之極低體重早產兒的存活率不斷地提升，但這些早產兒的父母最關心的還是他們的預後如何。
台北市立聯合醫院婦幼院區過去三年來總共有68個出生體重小於1500公克的早產兒，一年存活率為70.3%。結局不好的早產兒，有較輕的出生體重，較少的懷孕週數，一分鐘和五分鐘的Apgar分數較低，較少採剖腹產，有較高的比例產生呼吸窘迫症候群，及有較嚴重程度之腦出血。在多變數迴歸分析下只有低出生體重與嚴重腦出血和一歲時的預後有顯著的相關。單變數分析顯示嚴重腦出血的早產兒有較多的呼吸窘迫症候群和較少的剖腹產比例，但因剖腹產的嬰兒比陰道產的嬰兒有較高的懷孕週數，而減少了剖腹產本身可減少嚴重腦出血的預測能力。
日後要改善低出生體重早產兒的預後，須要產科醫師設法增加胎兒出生體重、在安胎時給予產前類固醇以避免出生後的呼吸窘迫症候群，對於極低體重的早產兒建議採剖腹產來避免腦出血。

關鍵字

早產兒 ； 極低出生體重嬰兒 ； 腦室內出血 ； 剖腹產 ； 神經發展預後

並列摘要

Survival rate of very-low-birth-weight (VLBW) infants has much improved in recent years. However, neurodevelopmental outcomes are still of the most concerned to such infants' parents. In order to survey survival rate, neurodevelopmental outcome and prognostic factors in these infants, we did a retrospective study of VLBW infants who were admitted to neonatal intensive care unit of Taipei City Hospital, Branch for Women and Children from 1(superscript st) January 2001 to 31(superscript th) October 2004. We reviewed their medical records and analyzed the data. A total of 68 cases were enrolled in this study, and overall one-year survival rate was 70.3% (45/64). The unfavorable outcome group had lower birth weight, lower gestational age, lower Apgar scores at 1-minute and 5-minute, higher rate of vaginal delivery, more respiratory distress syndrome (RDS), and higher IVH grades (all p value＜0.05). However, with multiple logistic regression analysis, only low birth weight and higher IVH grades were the significant predictors of unfavorable outcome. Univariate analysis showed that RDS increased but Cesarean section (C/S) decreased the risk of severe IVH. According to the result, we can make the conclusion that the survival rate of VLBW infants in our hospital was similar to that in other medical centers in Taiwan. In order to prevent severe grades of IVH and subsequent unfavorable outcome in VLBW infants, prenatal therapies to prevent RDS and perhaps choice of C/S as delivery mode are the best strategies.

並列關鍵字

prematurity ； very-low-birth-weight infant ； intraventricular hemorrhage ； cesarean section ； neurodevelopmental outcome