院外综合管理对支气管肺发育不良极早产儿近期预后的影响

doi:10.11852/zgetbjzz2016-24-08-22

摘要/Abstract

摘要： 目的通过与非支气管肺发育不良(BPD)极早产儿进行对比,探讨院外综合管理对BPD极早产儿近期预后的影响。方法选取2013年1月-2014年10月于中山大学附属第一医院出生并收住新生儿重症监护室(NICU)、存活时间≥28 d的极早产儿为研究对象,按有无合并BPD分为BPD组及非BPD组。对患儿出院后均进行规范随访及早期干预,比较两组患儿体格和神经系统发育情况、呼吸道症状发生率和再住院次数。结果符合入选标准有76例极早产儿,其中BPD患儿39例,BPD发生率51.3%。两组均无死亡、失明及脑瘫患儿。BPD组纠正3、6月龄及12月龄时体重、身长完成追赶性生长比例与非BPD组相仿(P≥0.05),但头围的追赶性生长较非BPD组差(P<0.05)。BPD组合并肺炎次数、哮喘发作次数、再入院次数明显高于非BPD组(P<0.05)。结论院外综合管理可改善BPD极早产儿预后,有助于促进其追赶性生长及减少神经系统不良预后,达到非BPD极早产儿水平,但未能降低其呼吸道症状发生率。

关键词: 支气管肺发育不良, 院外管理, 随访, 极早产儿, 预后

Abstract: Objective To prospectively evaluate the impact of discharge management on the short-term outcome of very preterm infants with bronchopulmonary dysplasia (BPD). Methods The preterm infants who were admitted in Neonatal Intensive Care Unit of the first Affiliated Hospital of Sun Yat-Sen University from January 2013 to October 2014 were enrolled.Their gestational age was<32 weeks and all of them survived ≥28 d.The very preterm infants were divided into BPD group and non-BPD group.All the infants received follow up and early interventions.Their growth parameters,neurodevelopment events and respiratory symptoms were evaluated regularly after discharge. Results Totally 76 preterm infants were enrolled and the morbidity of BPD was 51.3%.There was no death and cerebral palsy among these very preterm infants.Their growths in weight and length between BPD and non-BPD groups had no significant differences(P ≥0.05),while their growth in head circumference of BPD group was slower than that of non-BPD group(P<0.05).The incidences of pneumonia,wheezing and re-hospitalization in BPD group were significantly higher than those of non-BPD group(P<0.05). Conclusions Discharge management could improve the short-term outcome of very preterm infants with BPD.It could promote their growth and neurodevelopment without decreasing the incidence of respiratory symptoms after discharge.

Key words: outcome, brochopulmonary dysplasia, outpatient management, follow up, very preterm

中图分类号:

:R179

冯媚媚,刘王凯,李晓瑜,余慕雪,庄思齐,李易娟. 院外综合管理对支气管肺发育不良极早产儿近期预后的影响[J]. 中国儿童保健杂志, 2016, 24(8): 859-862.

FENG Mei-mei,LIU Wang-kai,LI Xiao-yu,YU Mu-xue,ZHUANG Si-qi,LI Yi-juan.. Impact of outpatient management on the short-term outcome of very preterm infant with brocopulmonary dysplasia.[J]. journal1, 2016, 24(8): 859-862.

参考文献

[1] Stoll BJ,Hansen NI,Bell EF,et al.Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network[J].Pediatrics,2010,126(3):443-456.
[2] 丁国芳.支气管肺发育不良患儿出院后管理[J].中国实用儿科杂志,2014,29(1):15-18.
[3] Khetan R,Hurley M,Spencer S,et al.Bronchopulmonary dysplasia within and beyond the neonatal unit[J].Adv Neonatal Care,2016,16(1):17-25.
[4] Lawn JE,Gravett MG,Nunes TM,et al.Global report on preterm birth and stillbirth (1 of 7):definitions,description of the burden and opportunities to improve data[J].BMC Pregnancy Childbirth,2010,10(Suppl 1):S1.
[5] Bhandari A,Bhandari V.Pitfalls,problems,and progress in bronchopulmonary dysplasia[J].Pediatrics,2009,123(6):1562-1573.
[6] 庄思齐.早产、低出生体重儿出院后管理[J].中国儿童保健杂志,2016,24(2):113-114.
[7] Groothuis JR,Makari D.Definition and outpatient management of the very low-birth-weight infant with bronchopulmonary dysplasia[J].Adv Ther,2012,29(4):297-311.
[8] 首都儿科研究所,九市儿童体格发育调查协作组.中国七岁以下儿童体重、身长/身高和头围的生长标准值及标准化生长曲线[J].中华儿科杂志,2009,47(3):173-178.
[9] 吴卫红,鲍秀兰,席冰玉,等.0～1岁52项神经运动检查和简化20项相关性研究[J].中国儿童保健杂志,2014,22(3):310-312.
[10] 《中华儿科杂志》编辑委员会,中华医学会儿科学分会神经学组.小儿脑性瘫痪的定义、诊断条件及分型[J].中华儿科杂志,2005,43(4):262.
[11] Guimares H,Rocha G,Pissarra S,et al.Respiratory outcomes and atopy in school-age children who were preterm at birth,with and without bronchopulmonary dysplasia[J].Clinics (Sao Paulo),2011,66(3):425-430.
[12] Sonnenschein-van der Voort AM,Arends LR,de Jongste JC,et al.Preterm birth,infant weight gain,and childhood asthma risk:a meta-analysis of 147 000 European children[J].J Allergy Clin Immunol,2014,133(5):1317-1329.
[13] 早产儿支气管肺发育不良调查协作组.早产儿支气管肺发育不良发生率及高危因素的多中心回顾调查分析[J].中华儿科杂志,2011,49(9):655-662.
[14] 《中华儿科杂志》编辑委员会,中华医学会儿科学分会新生儿学组.早产儿管理指南[J].中华儿科杂志,2006,44(3):188-191.
[15] Paolo T.The high-risk newborns[J].J Matern Fetal Neonatal Med,2012,25:6-7.
[16] Pérez TS,Rueda ES,Alfonso DJ,et al.Guidelines for the follow up of patients with bronchopulmonary dysplasia[J].An Pediatr(Barc),2016,84(1):61,e1-9.
[17] 程亚颖,冯琪,王颖.三级医院早产儿出院后随访现状及影响因素分析[J].中国新生儿科杂志,2015,30(6):401-407.
[18] 杨晓华,黄越芳,庄思齐,等.早产极低出生体重儿宫外生长迟缓发生状况及其危险因素[J].中华围产医学杂志,2015,18(2):87-93.
[19] Johnson DB,Cheney C,Monsen ER.Nutrition and feeding in infants with bronchopulmonary dysplasia after initial hospital discharge:risk factors for growth failure[J].J Am Diet Assoc,1998,98(6):649-656.
[20] Lai NM,Rajadurai SV,Tan KH.Increased energy intake for preterm infants with(or developing)bronchopulmonary dysplasia/chronic lung disease[J].Cochrane Database Syst Rev 2006,19(3):CD00509.
[21] McLeod G,Simmer K,Benninger H,et al.Preterm infants with chronic lung disease:are protein and energy intakes after discharge sufficient for optimal growth?[J].J Paediatr Child Health,2011,47(3):127-33.
[22] 周文浩,陈燕琳.早产儿支气管肺发育不良远期结局[J].中国实用儿科杂志,2014,29(1):18-24.
[23] Vom Hove M,Prenzel F,Uhlig HH,et al.Pulmonary outcome in former preterm,very low birth weight children with bronchopulmonary dysplasia:a case-control follow-up at school age[J].J Pediatr,2014,164(1):40-45.
[24] 卫敏超,余家林,刘晓红等.不同程度支气管肺发育不良患儿潮气呼吸肺功能特征[J].中华医学杂志,2013,39(22):1716-1720.
[25] Saarenp HK,Tikanmki M,Sipola-Leppnen M,et al.Lung function in very low birth weight adults[J].Pediatrics,2015,136(4):642-650.
[26] Gibson AM,Reddington C,McBride L,et al.Lung function in adult survivors of very low birth weight,with and without bronchopulmonary dysplasia[J].Pediatr Pulmonol,2015,50(10):987-94.
[27] Smith VC,Zupancic JA,McCormick MC,et al.Rehospitalization in the first year of life among infants with bronchopulmonary dysplasia[J].J Pediatr,2004,144(6):799-803.
[28] Neubauer V,Junker D,Griesmaier E,et al.Bronchopulmonary dysplasia is associated with delayed structural brain maturation in preterm infants[J].Neonatology,2015,107(3):179-184.
[29] Trittmann JK,Nelin LD,Klebanoff MA.Bronchopulmonary dysplasia and neurodevelopmental outcome in extremely preterm neonates[J].Eur J Pediatr,2013,172(9):1173-1180.