重度子痫前期极早产小于胎龄儿临床特点分析

Clinical features of very preterm small-for-gestational-age infants born due to severe preeclampsia

摘要:

目的 回顾性分析并总结因重度子痫前期剖宫产娩出的极早产小于胎龄儿的临床特点。方法 选取2017年8月至2018年7月收治的因重度子痫前期娩出的42例极早产小于胎龄儿作为观察组，以同期健康母亲单纯因宫缩不能抑制娩出的极早产儿40例作为对照组，分析两组围生期特点、感染方面的临床表现、并发症、临床结局等。结果 观察组生后6 h内、2~3 d时的白细胞（WBC）计数、中性粒细胞绝对计数（ANC）、血小板（PLT）计数均低于对照组（P < 0.05）；5~7 d时，观察组ANC、PLT计数仍低于对照组（P < 0.05）。生后2~3 d及5~7 d时观察组C反应蛋白（CRP）水平高于对照组（P < 0.05）。观察组发生重症感染的百分率明显高于对照组（P < 0.05）。观察组生后6 h内血红蛋白水平高于对照组（P < 0.05）。观察组支气管肺发育不良发生率明显高于对照组（P < 0.05），两组在肺出血、颅内出血、新生儿坏死性小肠结肠炎、早产儿视网膜病发生率，以及有创呼吸机使用率和临床结局上比较差异均无统计学意义（P > 0.05）。结论 极早产重度子痫前期小于胎龄儿感染发生率高，病情表现重，早期感染指标以WBC计数、ANC、PLT计数降低为主要表现，CRP在其生后早期升高不明显，2~3 d时逐步升高。该类患儿生后绝大部分需要有创机械通气，并发症以支气管肺发育不良为主，临床上应密切观察其临床变化并监测炎性指标，早期识别感染，及时诊断，及时调整抗生素治疗，以提高救治率。

Abstract:

Objective To study the clinical features of very preterm small-for-gestational-age infants born by cesarean section due to severe preeclampsia. Methods Forty-two small-for-gestational-age infants who were admitted from August 2017 to July 2018 and were born due to severe preeclampsia were enrolled as the observation group. Forty very preterm infants who were born to healthy mothers since uterine contractions could not be suppressed were enrolled as the control group. Perinatal features, clinical manifestations of infection, complications, and clinical outcomes were analyzed for the two groups. Results Within 6 hours and 2-3 days after birth, the observation group had significantly lower white blood cell count (WBC), absolute neutrophil count (ANC), and platelet count (PLT) than the control group (P < 0.05). At 5-7 days after birth, there was no significant difference in WBC between the two groups (P > 0.05), while the observation group still had significantly lower ANC and PLT than the control group (P < 0.05). The observation group had a significantly higher C-reactive protein (CRP) level than the control group at 2-3 days and 5-7 days after birth (P < 0.05). The observation group had a significantly higher proportion of infants with severe infections than the control group (P < 0.05). The observation group had a significantly higher hemoglobin level than the control group within 6 hours after birth (P < 0.05). The observation group had a significantly higher incidence rate of bronchopulmonary dysplasia than the control group (P < 0.05). There was no significant difference between the two groups in the rate of pulmonary hemorrhage, intracranial hemorrhage, neonatal necrotizing enterocolitis, retinopathy of prematurity, and the rate of use of invasive ventilation, and clinical outcomes (P > 0.05). Conclusions Very preterm small-for-gestational-age infants born due to severe preeclampsia have a high incidence rate of infection and severe conditions. Early manifestations include reductions in the infection indicators WBC, ANC, and PLT, and CRP does not increase significantly in the early stage and gradually increases at 2-3 days after birth. Most of these infants require invasive ventilation after birth, with bronchopulmonary dysplasia as the main complication. Clinical changes should be closely observed and inflammatory indicators should be monitored for early identification of infection, timely diagnosis, and timely adjustment of antibiotic treatment, so as to improve the outcome.