一名早产儿的支气管肺发育不良——病例报告及文献综述

George I O, Frank-Briggs A I, Nyengidiki T K

Department of Paediatrics, University of Port-Harcourt Teaching Hospital, Port-Harcourt.

Niger J Med. 2010 Jan-Mar;19(1):108-11. doi: 10.4314/njm.v19i1.52499.

BACKGROUND

Bronchopulmonary dysplasia is an important cause of morbidity and mortality in premature infants. The aim of this study is to present a premature, extremely low birth weight infant with bronchopulmonary dysplasia.

METHOD

A review of the case records of a child with recurrent respiratory distress and the relevant literature.

RESULTS

A preterm, extremely low birth weight baby (birth weight was 0.8 Kg), delivered by emergency caesarian section for previous caesarian section and prolonged rupture of fetal membranes at 27 weeks gestational age. She had spontaneous breathing at birth (APGAR scores were 8 in one minute and 10 in 5 minutes). She developed respiratory distress with cyanosis and became oxygen dependent from the second week of life. Examination revealed severe dyspnoea with grunting respiration, tachypnoea, cyanosis and crackles in the lung fields. Chest X-ray showed hyperinflation, right lower zone patchy consolidation with obliteration of the costophrenic angle. Echocardiography was however normal. She was successively managed with intermittent oxygen, dexamethasone, salbutamol and antibiotics (ceftriaxone). She was nursed in the incubator for 3 months. There was no episode of apneic attack throughout admission. She responded to treatment and was discharged home on intermittent oxygen therapy and nebulisation. The weight on discharge was 1.6 kg. At 6 months of age, she is still having recurrent respiratory distress andsupplemental oxygen at home. She is regular to follow up with recurrent episodes of wheeze requiring admissions.

CONCLUSION

Bronchopulmonary dysplasia should be suspected in a premature extremely low birth weight infant with early recurrent respiratory distress.

背景

支气管肺发育不良是早产儿发病和死亡的重要原因。本研究旨在介绍一名患有支气管肺发育不良的早产极低出生体重儿。

方法

回顾一名反复出现呼吸窘迫患儿的病例记录及相关文献。

结果

一名早产极低出生体重儿（出生体重0.8千克），因既往剖宫产及孕27周胎膜早破行急诊剖宫产分娩。出生时自主呼吸（1分钟阿氏评分8分，5分钟阿氏评分10分）。出生后第二周出现呼吸窘迫伴发绀，开始依赖吸氧。检查发现严重呼吸困难、呻吟样呼吸、呼吸急促、发绀及肺部湿啰音。胸部X线显示肺过度充气，右下肺斑片状实变，肋膈角消失。然而，超声心动图正常。先后给予间歇给氧、地塞米松、沙丁胺醇及抗生素（头孢曲松）治疗。在暖箱中护理3个月。住院期间未发生呼吸暂停发作。对治疗有反应，出院时接受间歇氧疗和雾化治疗。出院时体重1.6千克。6个月大时，仍反复出现呼吸窘迫，在家中需吸氧。定期随访，反复出现喘息发作需住院治疗。