Atasay Begüm, Günlemez Ayla, Unal Sevim, Arsan Saadet
Division of Neonatology, Department of Pediatrics, Ankara University, Faculty of Medicine, Ankara, Turkey.
Turk J Pediatr. 2003 Oct-Dec;45(4):283-9.
Our purpose was to determine mortality and morbidity rates and selected outcome variables for infants weighing less than 1500 g, who were admitted to the neonatal intensive care unit of our hospital from 1997 to 2000. The ultimate goal of the study was to define a model for developing a regional database. Information on all very low birth weight (VLBW) admissions to a tertiary level neonatal intensive care unit (NICU) in Ankara between January 1997 and December 2000 was prospectively collected by three neonatologists using a standard manual of operation and definitions. The data consisted of patient information including sociodemographic characteristics; antenatal history; mode of delivery; APGAR scores; need for resuscitation; admission illness severity (Clinical Risk Index for Babies-CRIB) and therapeutic intensity (Neonatal Therapeutic Intensity Scoring System-NTISS); selected NICU parameters and procedures such as respiratory support, surfactant therapy, and postnatal corticosteroid therapy; and selected patient outcomes such as intraventricular hemorrhage, septicemia, necrotizing enterecolitis, retinopathy of prematurity, and chronic lung disease. The number of VLBW admissions to the NICU was 133, with 51 (28.6%) referrals from other maternity centers. The mean birth weight and gestational age of the infants were 1175 +/- 252 g and 30.3 +/- 2.9 weeks, respectively. One hundred and seventeen of 133 cases (88.7%) received at least one antenatal care visit. The median CRIB and NTISS scores were 4.5 and 31, respectively. Antenatal steroids had been given to 74 (55.6%) infants. Surfactant treatment and respiratory support were given to 33 (24.8%) and 73 (54.8%) infants, respectively. Among selected outcomes, chronic lung disease (CLD), threshold retinopathy of prematurity (ROP), severe intraventricular hemorrhage (IVH > or = grade III), nosocomial infection and necrotizing enterocolitis (NEC) were encountered in 14 (12.6%), 9 (8.1%), 3 (2.2%), 34 (25.5%) and 35 (26.3%) of the infants, respectively. Overall survival rate was 83.5% (111/133); most of the deceased cases were under 750 g (12/22). It was prospectively shown that 111 (100%) of the surviving infants could be regularly followed in a newborn follow-up clinic to provide health maintenance, developmental assessment and support. Compared with reports from other developing countries, VLBW infants at our center had higher survival rates. Compared to developed countries, survival rate was lower, especially for extremely very low birth weight infants. There is interaction between birth weight and survival rate. Among selected neonatal outcomes, chronic lung disease, threshold retinopathy, severe intraventricular hemorrhage (IVH > or = grade III) and nosocomial infection rates at this center were comparable with some reports from developed nations.
我们的目的是确定1997年至2000年期间入住我院新生儿重症监护病房、体重不足1500克的婴儿的死亡率和发病率以及选定的结局变量。该研究的最终目标是定义一个用于建立区域数据库的模型。1997年1月至2000年12月期间，安卡拉一家三级新生儿重症监护病房（NICU）收治的所有极低出生体重（VLBW）婴儿的信息由三位新生儿科医生使用标准操作手册和定义进行前瞻性收集。数据包括患者信息，如社会人口统计学特征、产前病史、分娩方式、阿氏评分、复苏需求、入院时疾病严重程度（婴儿临床风险指数-CRIB）和治疗强度（新生儿治疗强度评分系统-NTISS）；选定的NICU参数和程序，如呼吸支持、表面活性剂治疗和产后皮质类固醇治疗；以及选定的患者结局，如脑室内出血、败血症、坏死性小肠结肠炎、早产儿视网膜病变和慢性肺病。入住NICU的VLBW婴儿有133例，其中51例（28.6%）是从其他产科中心转诊而来。婴儿的平均出生体重和胎龄分别为1175±252克和30.3±2.9周。133例病例中有117例（88.7%）至少接受过一次产前检查。CRIB和NTISS评分的中位数分别为4.5和31。74例（55.6%）婴儿接受过产前类固醇治疗。分别有33例（24.8%）和73例（54.8%）婴儿接受了表面活性剂治疗和呼吸支持。在选定的结局中，分别有14例（12.6%）、9例（8.1%）、3例（2.2%）、34例（25.5%）和35例（26.3%）婴儿出现慢性肺病（CLD）、阈值早产儿视网膜病变（ROP）、重度脑室内出血（IVH≥III级）、医院感染和坏死性小肠结肠炎（NEC）。总体存活率为83.5%（111/133）；大多数死亡病例体重低于750克（12/22）。前瞻性研究表明，111例（100%）存活婴儿可以在新生儿随访诊所定期接受随访，以提供健康维护、发育评估和支持。与其他发展中国家的报告相比，我们中心的VLBW婴儿存活率更高。与发达国家相比，存活率较低，尤其是极低出生体重婴儿。出生体重和存活率之间存在相互作用。在选定的新生儿结局中，该中心的慢性肺病、阈值视网膜病变、重度脑室内出血（IVH≥III级）和医院感染率与一些发达国家的报告相当。
