Morbidity and Mortality of Neonatal Respiratory Failure in China: Surfactant Treatment in Very Immature Infants
Morbidity and Mortality of Neonatal Respiratory Failure in China: Surfactant Treatment in Very Immature Infants
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DOI：
10.1542/peds.2011-0725
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发表时间：
2012-03-01
期刊：
影响因子：
8
通讯作者：
Sun, Bo
中科院分区：
文献类型：
--
作者：
Wang, Huanhuan;Gao, Xirong;Sun, Bo
目的：我们回顾性调查了中国新生儿呼吸衰竭（NRF）的发病率、发病率和死亡率，特别强调了表面活性剂治疗的极不成熟的婴儿。方法：NRF定义为呼吸性低氧血症，需要机械通气和/或经鼻持续气道正压通气至少24小时。有6864例NRF，占2008年55个NICU总入院人数的19.7%。在这些病例中，62.8%为早产儿，16.4%为极低出生体重儿（VLBW，<1500 g）。原发病为呼吸窘迫综合征（RDS）43.9%，肺炎/脓毒症21.7%，一过性呼吸功能不全14.7%，一过性呼吸急促8.1%，胎粪吸入综合征7.0%。26.8%的NRF婴儿和54.8%的RDS婴儿使用了表面活性剂。表面活性剂治疗的RDS的存活率为79.9%，而未接受表面活性剂治疗的RDS的存活率为71.8%（P <0.001）。极低出生体重者也是如此，分别为59.8%和52.2%（P = 0.035）。NRF组总生存率为75.3%，VLBW组为58.1%，胎龄25、26、27~28周的存活率分别为6%、30%、50%;胎粪吸入综合征和肺炎/败血症患儿的存活率分别为70.3%和71.4%。护理负担与高治疗退出率和死亡率。结论：NRF的结果，特别是在极早产儿，反映了在中国新兴的NICU提供呼吸支持的进展和持续的局限性，但患病新生儿的总体生存率稳步提高。儿科2012; 129：e731-e740
OBJECTIVES: We retrospectively investigated incidence, morbidity, and mortality of neonatal respiratory failure (NRF) in China, with special emphasis on surfactant treated very immature infants.METHODS: NRF was defined as respiratory hypoxemia requiring mechanical ventilation and/or nasal continuous positive airway pressure for at least 24 hours.RESULTS: There were 6864 cases of NRF, composing 19.7% of total admissions to 55 NICUs in 2008. Of these cases, 62.8% were preterm, and 16.4% of very low birth weight (VLBW, < 1500 g). The primary diseases were respiratory distress syndrome (RDS, 43.9%), pneumonia/sepsis (21.7%), transient respiratory insufficiency (14.7%), transient tachypnea (8.1%), and meconium aspiration syndrome (7.0%). Surfactant was given to 26.8% of infants with NRF and 54.8% infants with RDS. The survival rate of surfactant-treated RDS was 79.9% compared to 71.8% in those not receiving surfactant (P < .001). This was also true in those of VLBW, 59.8% vs 52.2% (P = .035), respectively. The overall survival rate in NRF cases was 75.3%, but it was 58.1% among VLBW infants; for those infants of 25, 26, and 27 to 28 weeks' gestational age, the survival rates were similar to 6%, 30%, and 50%, respectively; and the survival rates for infants with meconium aspiration syndrome and pneumonia/ sepsis were 70.3% and 71.4%, respectively. The care burden was associated with high treatment withdrawal and death rate.CONCLUSIONS: The outcomes of NRF, especially in extremely premature infants, reflect both progress and persistent limitations in providing respiratory support in the emerging NICUs of China, but overall survival for sick newborns had improved steadily. Pediatrics 2012; 129: e731-e740