Sims M E, Turkel S B, Vazirani M, Hodgman J E
Department of Pediatrics, University of Southern California School of Medicine, Los Angeles.
J Perinatol. 1988 Spring;8(2):88-92.
Although survival of low birth weight infants during the neonatal period has improved, an increasing percentage of infants succumb after 28 days but before discharge from the nursery. In a retrospective study we compared 11 postponed neonatal deaths (PND) with survivors matched for birth weight, gestational age, gender, race, inborn or outborn status, and year of birth in an attempt to identify possible differentiating factors early in the clinical course. Evaluation of antenatal, intrauterine, and early nursery events could not differentiate the two groups. By day 14, however, significantly more PND required assisted ventilation because of poor respiratory effort and total parenteral nutrition because of poor gastrointestinal motility. Metabolic differences were noted at this time in the serum bilirubin, phosphorus, and chloride levels. At autopsy all infants had evidence of CNS injury, and moderate chronic lung disease, and in addition nine infants had bronchopneumonia. The major differences between the PNDs and survivors may primarily involve neurologic control of respiration and gastrointestinal motility. Early recognition of PND may have important medical, ethical, and financial implications for newborn intensive care.
尽管低出生体重儿在新生儿期的存活率有所提高，但在出生28天后至离开保育室前死亡的婴儿比例却在增加。在一项回顾性研究中，我们将11例延迟性新生儿死亡（PND）与出生体重、胎龄、性别、种族、是否为院内出生或院外出生以及出生年份相匹配的存活者进行了比较，试图在临床过程早期确定可能的区分因素。对产前、宫内和早期保育室事件的评估未能区分这两组。然而，到第14天时，因呼吸努力不佳而需要辅助通气以及因胃肠动力差而需要全胃肠外营养的PND患儿明显更多。此时在血清胆红素、磷和氯水平上发现了代谢差异。尸检时所有婴儿均有中枢神经系统损伤和中度慢性肺病的证据，此外还有9例婴儿患有支气管肺炎。PND患儿与存活者之间的主要差异可能主要涉及呼吸和胃肠动力的神经控制。早期识别PND可能对新生儿重症监护具有重要的医学、伦理和经济意义。
