Department of Neonatology, Lady Hardinge Medical College - Kalawati Saran Children Hospital, , New Delhi, India.
Postgrad Med J. 2013 Dec;89(1058):679-84. doi: 10.1136/postgradmedj-2012-131736. Epub 2013 Aug 6.
Perinatal care has changed dramatically over last decade contributing to improved survival of extremely low birthweight (ELBW) babies.
We conducted the present study with the objective to identify immediate obstetric causes of preterm delivery; analyse the maternal risk factors and to evaluate the morbidity and mortality of ELBW babies delivered in our hospital. The results were compared with those of 10 years ago from the same hospital to determine whether there has been any significant change in the predictors of mortality
A retrospective analysis of case records of 283 ELBW babies delivered in our hospital over a period of 24 months from 1 April 2010 to 31 March 2012 was conducted.
The total neonatal mortality rate was 38.7%. 85 babies (30%) were small for gestational age. Mean gestational age and mean birth weight was 28.5 weeks and 883.4 g, respectively. Using multivariate logistic regression analysis, significant risk factors for neonatal mortality in mothers were anaemia (p=0.00001, OR 3.13, CI 1.756 to 5.56), inadequate antenatal care (p=0.00001, OR 4.74, CI 2.59 to 8.69) premature rupture of membrane with antenatal antibiotic usage (p=0.003, OR 3.375, CI 1.512 to 7.53. Risk factors for mortality in babies were male sex (p=0.08, OR 3.48 CI 1.4 to 8.8), lower birth weight (p=0.000005), lower gestational age (p=0.00001) use of respiratory support in the form of continuous positive airway pressure (p=0.03), or mechanical ventilation (p=0.00001) and pulmonary or intraventricular haemorrhage (p=0.0001).
Babies with lower gestational age lower birth weight and those babies whose mothers had not received adequate antenatal care or antenatal steroids had worse prognosis.
过去十年间，围产期护理发生了巨大变化，这使得极低出生体重儿（ELBW）的存活率得到了提高。
本研究旨在确定早产的即时产科原因；分析产妇的危险因素，并评估在我院分娩的 ELBW 婴儿的发病率和死亡率。将这些结果与同一医院 10 年前的数据进行比较，以确定死亡率的预测因素是否发生了显著变化。
对 2010 年 4 月 1 日至 2012 年 3 月 31 日期间在我院分娩的 283 名 ELBW 婴儿的病历进行回顾性分析。
总的新生儿死亡率为 38.7%。85 名婴儿（30%）为小于胎龄儿。平均胎龄和平均出生体重分别为 28.5 周和 883.4 克。使用多变量逻辑回归分析，母亲发生新生儿死亡的显著危险因素为贫血（p=0.00001，OR 3.13，CI 1.756 至 5.56）、产前保健不足（p=0.00001，OR 4.74，CI 2.59 至 8.69）、胎膜早破并使用产前抗生素（p=0.003，OR 3.375，CI 1.512 至 7.53）。婴儿死亡的危险因素为男性（p=0.08，OR 3.48，CI 1.4 至 8.8）、出生体重较低（p=0.000005）、胎龄较小（p=0.00001）、使用持续气道正压通气（p=0.03）或机械通气（p=0.00001）以及肺或脑室出血（p=0.0001）。
胎龄较小、出生体重较低且母亲未接受充分产前保健或产前类固醇治疗的婴儿预后较差。
