Objective To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants. Methods The general clinical data of preterm infants with gestational age 24-36+ 6 weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed. Results The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ2=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ2=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ2=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis. Conclusions HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications. Key words: Hypertensive disorders complicating pregnancy; Infants, premature; Complications

目的 报道国内14家医院产科收治的出生胎龄24～31周早产儿的早期病死率和主要并发症发生率,并分析其影响因素.方法 收集2013年1月1日至2014年12月31日国内14家医院产科收治的出生胎龄24～31周早产儿的一般资料,分析各胎龄组早产儿的病死率和主要并发症如支气管肺发育不良(bronchopulmonary dysplasia,BPD)、新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、早产儿视网膜病(retinopathy of prematurity,ROP)、脑室内出血(intraventricular hemorrhage,IVH)和败血症等的发生率,并分析其影响因素.结果 24～31周各胎龄组早产儿的存活率分别为0、28.0％、84.8％、83.5％、87.4％、90.7％、93.9％和96.0％,无严重合并症存活率分别为0、8.0％、60.6％、53.2％、62.3％、67.9％、79.1％和85.8％,随着胎龄的增加存活率及无严重合并症存活率均增加.胎龄<28周早产儿的产前激素使用率低于28～31周(28.0％～44.3％vs 49.7％～59.6％,P<0.05),总体使用率为56.0％,足疗程为32.3％.早产儿胎龄越小,并发症发生率越高.24～31周早产儿总体呼吸窘迫综合征的发生率为58.5％,BPD的发生率为12.5％,NEC的发生率为3.9％,IVH的发生率为15.4％,ROP的发生率为5.4％,动脉导管未闭的发生率为28.4％,败血症的发生率为9.7％.低胎龄(OR=0.891,95％CI:0.796～0.999,P=0.0047)、低出生体重(OR=0.520,95％CI:0.420～0.643,P=0.000)、小于胎龄儿(OR=1.861,95％CI:1.148～3.017,P=0.012)和5分钟低Apgar评分(OR=1.947,95％CI:1.269～2.987,P=0.002)是早产儿死亡的高危因素.低胎龄(OR=0.666,95％CI:0.645～0.688,P=0.000)、低出生体重(OR=0.921,95％CI:0.851～0.997,P=0.041)、男性(OR=1.235,95％CI:1.132～1.347,P=0.000)、小于胎龄儿(OR=1.511,95％CI:1.300～1.755,P=0.000)、5分钟时低Apgar评分(OR=2.262,95％CI:1.950～2.624,P=0.000)以及围产期合并症如前置胎盘(OR=1.452,95％CI:1.202～1.753,P=0.000)、胎盘早剥(OR=1.380,95％CI:1.082～1.760,P=0.010)、妊娠期高血压疾病(OR=2.262,95％CI:1.950～2.624,P=0.000)、多胎(OR=1.162,95％CI:1.056～1.278,P=0.002)和产前发热(OR=1.367,95％CI:1.228～1.521,P=0.000)等是早产儿并发症发生的高危因素.产前使用激素治疗可以降低超早产儿和极早产儿的死亡风险(OR=0.615,95％CI:0.483～0.801,P=0.033).结论 胎龄26周以下超早产儿的存活率较低,26～31周早产儿的存活率虽逐渐接近发达国家,但严重并发症的发生率较高,提高对围产期合并症的预防和管理有助于改善此类早产儿的生存质量.

OBJECTIVE:To investigate the effect of premature rupture of the membrane (PROM) on neonatal complications in premature infants. METHODS:The registration information of 7684 preterm infants with gestational age <37 weeks were collected from the cooperative units in the task group between January 1, 2014 to December 31, 2014. Specially trained personnel from each cooperative units filled in the unified form in a standardized format to record the gender, gestational age, birth weight, PROM, placental abruption, antenatal corticosteroid, Apgar score, amniotic fluid pollution, and complications of the infants. The data were analyzed comparatively between the cases with PROM and those without (control). RESULTS:The preterm mortality rate was significantly lower but the incidences of ICH, NEC, ROP and BPD were significantly higher in PROM group than in the control group (P<0.05). The 95% confidence interval of the OR value was <1 for mortality, and was >1 for ICH, NEC, ROP and BPD. After adjustment for gestational age, birth weight, gender, mode of delivery, placental abruption, placenta previa, prenatal hormones, gestational diabetes mellitus (GDM), gestational period hypertension and 5-min Apgar score <7, the incidences of NEC, ROP and BPD were significantly different between the two groups (P<0.05) with 95% confidence interval of OR value >1, but the mortality rate and incidence of ICH were not significantly different between the two groups (P>0.05). CONCLUSION:PROM is a risk factor for NEC, ROP and BPD in preterm infants, and adequate intervention of PROM can reduce the incidences of such complications as NEC, ROP and BPD in the infants.

Objective To investigate the morbidity, mortality, characteristics of the complications, high risk factors and the effects of antenatal corticosteroids on the morbidity and prognosis of respiratory distress syndrome in inborn preterm neonates in China.MethodData were collected from January 1, 2014 to December 31, 2014 for premature with gestational age <37 weeks born in Obstetric. The morbidity, mortality, characteristics of the complications, high risk factors, effect of antenatal corticosteroids were analysis retrospectively.ResultsFrom a total of 75 360 live birth newborns, there were 7 684 cases (10.2%) of preterm neonates, of which 957 cases (12.5%) were extreme prematurity and 92 cases(1.2%) were severe/moderate prematurity. Of these preterm neonates, a total of 1 177 were classified as RDS(15.3%). The morbidity of RDS in neonateswith 24≤GA<25、25≤GA<26、26≤GA<27、27≤GA<28、28≤GA<29、29≤GA<30、30≤GA<31、31≤GA<32、32≤GA<33、33≤GA<34、34≤GA<35、35≤GA<36 and 36≤GA<37 weeks were 100.0%、90.0%、85.0%、85.1%、81.0%、74.3%、55.4%、47.1%、33.1%、17.9%、9.6%、5.0% and 1.9%, respectively. The morbidity of RDS in preterm neonates with BW<500,500-749, 750-999, 1 000-1 499,1 500-2 499, 2 500-4 000 and more than 4 000 grams were 100.0%,100.0%,79.2%, 55.8%, 15.0%, 3.6% and 9.5%, respectively. The mortality of preterm neonates with RDS was 10.5%. The mortality of RDS in neonates with 24≤GA<25、25≤GA<26、26≤GA<27、27≤GA<28、28≤GA<29、29≤GA<30、30≤GA<31、31≤GA<32、32≤GA<33、33≤GA<34、34≤GA<35、35≤GA<36 and 36≤GA<37 weeks were 100.0%,70.0%, 23.5%, 20.0%, 16.2%, 10.3%, 8.1%, 9.6%, 8.9%, 6.0%, 5.5%, 8.8% and 4.5%, respectively. The incidence of ICH, ROP, BPD, NEC, PDA, pulmonary hemorrhage and sepsis in preterm neonates with RDS were higher than those without RDS. Logistic regressions showed that male, GA<33 weeks, BW<2 500 grams, body length <40 cm, neonatal asphyxia production time≥2 times , and placenta praevia were risk factors for RDS. Multiple pregnancy was protection factor for RDS. In preterm neonates with GA<33 weeks, male, GA<28 weeks, BW<2 500 grams, body length <40 cm, neonatal asphyxia and placenta praevia were risk factors for RDS. Prenatal dexamethasone was protection factor for RDS. In preterm neonates with GA≥33 weeks, male, GA<35 weeks, BW<2 500 grams, neonatal asphyxia, production time≥2 times, cesarean delivery, placenta previawere risk factors for RDS. Multiple pregnancy was protection factor for RDS. 2 879 cases under went antenatal dexamethasone therapy, corresponding to 37.5%. There was a lower incidence of RDS in neonates with GA<33 weeks in antenatal corticosteroids group compared with non-antenatal corticosteroids group. For neonates with GA<33 weeks, the incidence of RDS and severe RDS, the mortalitywere lower in antenatal corticosteroids group compared with non-antenatal corticosteroids group. The proportion of patients received≥2 doses of surfactant,the proportion of patients received mechanical ventilation and the median length of mechanical ventilation were lower in antenatal corticosteroids group compared with non-antenatal corticosteroids group,but the differences were not statistically signiifcant. The mean duration of oxygen supplement were longer in antenatal corticosteroids group compared with non-antenatal corticosteroids group, but the differences were not statistically signiifcan. The median length of stay in NICU were longer in antenatal corticosteroids group compared with non-antenatal corticosteroids group.For preterm neonates with GA≥33 weeks with RDS, the incidence of RDS and severe RDS, the proportion of patients received mechanical ventilation, the mean duration of oxygen supplement andthe median length of stay in NICU were higher in antenatal corticosteroids group compared with non-antenatal corticosteroids group. But the other differences between these two groups was not statistically signiifcant.Conclusions The incidence of preterm neonates in China increased. The survival rate in preterm neonates, extreme prematurity and severe/moderate prematurity improved obviously than ever before. The mortality and morbidity of complications of preterm neonates with RDS was higher than those without RDS. Most of the high risk factors of RDS in preterm neonates with GA<33 weeks were related to their immature lung development. Prenatal dexamethasone can effectively reduce the incidence of RDS and improve the prognosis. For preterm neonates with GA≥33 weeks, the high risk factors of RDS tended to be related to perinatal factors, the protective effect of dexamethasone was not obviously.