目的：分析极低出生体质量(VLBW)婴儿的短期预后。方法回顾性分析2013年12月至2014年12月收治的VLBW婴儿随访至纠正6月龄的生存质量。结果共入选230例符合标准的VLBW婴儿，出院时死亡30例(13.0%)，放弃治疗40例(17.4%)，好转签字出院60例(26.1%)，治愈100例(43.5%)。30例死亡VLBW婴儿中，主要为新生儿呼吸窘迫综合征18例、肺出血5例、败血症3例。200例存活婴儿随访至纠正6月龄时，13例(6.5%)失访；54例(27.0%)死亡，其中40例是因经济原因放弃治疗或好转签字出院的。纠正1、3、6月龄时，继续随访的VLBW婴儿身长、体质量均随月龄增长逐渐接近儿童生长标准，但至纠正6月龄时仍明显落后于儿童生长标准；身长落后较体质量落后更明显。109例患儿行眼底筛查，其中早产儿视网膜病变Ⅰ期21例、Ⅱ期7例，眼底出血行激光光凝术6例；98例患儿行听力筛查，单侧未通过5例，双侧未通过11例；95例患儿行头颅磁共振成像(MRI)检查，颅内出血10例，早产儿脑损伤9例。49例患儿纠正胎龄42周行新生儿神经行为测定(NBNA)均≤35分；纠正3月龄时，36例患儿行Gesell发育量表评估，轻度发育迟缓11例、中度2例；纠正6月龄时，24例行Gesell发育量表评估，轻度发育迟缓2例。VLBW婴儿在适应能力、社交行为、大运动方面进步较快。结论经济条件及新生儿呼吸窘迫综合征、肺出血、败血症是影响VLBW婴儿存活及生存质量的重要因素；存活VLBW婴儿的生长发育均有逐渐好转现象。%Objective To analyze the short term prognosis of very low birth weight (VLBW) infants. Methods The clinical data of VLBW infants who were hospitalized from December 2013 to December 2014 and followed up to 6 months of corrected age were retrospectively analyzed. Results A total of 230 VLBW infants were enrolled. Thirty infants (13.0%) died during hospitalization, 40 infants (17.4%) were given up the treatment, 60 infants (26.1%) were improved at discharge, and 100 infants (43.4%) were cured at discharge. In the 30 cases of death, causes of death were mainly neonatal respiratory distress syndrome (18 cases), pulmonary hemorrhage (5 cases), and sepsis (3 cases). In the 200 survived infants at discharge, at 6 months of corrected age of follow-up, 13 infants (6.5%) were lost to follow-up, and 54 infants (27.0%) died, among whom 40 infants died because of giving up therapeutic intervention due to economic factor or discharges without permission. At 1, 3, 6 month of follow-up, the length and weight of VLBW infants were gradually approaching normal, and, however, at 6 months of corrected age, the length and weight of VLBW infants were still obviously below the children’s growth standard. The length of VLBW infants was more deeply below the growth standard than the weight. In 109 infants who had fundus ophthalmoscope, 21 cases had retinopathy of prematurity (ROP) I, and 7 cases had ROP II. In 98 infants who had the hearing screening test, 5 cases failed in one ear and 11 cases failed in both ears. In 95 infants who had the head magnetic resonance imaging (MRI) examination, 10 cases had intracranial hemorrhage and 9 cases had premature brain injury. In 49 infants who completed the neonatal behavioral neurological assessment (NBNA) at corrected age of 42 weeks, the scores were all lower than 35. In 36 infants who were assessed by Gesell developmental scale at the 3 months of corrected age, 11 cases had mild developmental delay and 2 cases had moderate developmental delay. In 24 infants who were assessed at the 6 months corrected age, only 2 cases had mild developmental delay. VLBW infants had a rapid progress in social contact, social behavior, and gross motor movement. Conclusions Economic, neonatal respiratory distress syndrome, pulmonary hemorrhage, and sepsis are pivotal factors for the survival and quality of life of VLBW infants. The surviving VLBW infants have catch-up growth and development.
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