(3.210.184.142) 您好!臺灣時間:2021/05/13 17:20
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:陳捷惠
研究生(外文):Jie Hui Chen
論文名稱:新生兒加護病房中低出生體重早產兒的罹病率與死亡率之長期趨勢探討
論文名稱(外文):Trends in morbidity and mortality for low birth weight preterm infants in neonatal intensive care unit
指導教授:李佳琳李佳琳引用關係
指導教授(外文):C. L. Lee
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
論文頁數:79
中文關鍵詞:低出生體重早產兒死亡率罹病率
外文關鍵詞:low birth weightpreterm infantsmortalitymorbidity
相關次數:
  • 被引用被引用:1
  • 點閱點閱:317
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:1
目的:本研究初探低出生體重早產兒之死亡與罹病的相關因素及長期趨勢。
方法:使用次級資料,觀察1996年至2005年十年期間,出生後二十八日內住入長庚醫院新生兒加護病房的低出生體重早產兒。
結果:於觀察期間,共有5065個低出生體重早產兒符合本研究篩選條件,(1)低出生體重早產兒死亡率顯著逐年下降,由1996年12.09%降至2005年4.39%,尤其是出生體重小於1000公克新生兒死亡率改善最多;(2)影響低出生體重早產兒死亡的相關因素為低妊娠週數、低出生體重、一分鐘阿普伽分數小於等於三分、五分鐘阿普伽分數小於等於三分、男性、有急救治療、持續高壓症;(3)早產兒視網膜病變、腦室內出血的整體罹病比例於1996至2005年無顯著變化,但嚴重早產兒視網膜病變與嚴重腦室內出血的罹病比例在2001至2005年期間卻有略增趨勢;罹患呼吸窘迫症、開放性動脈導管、慢性肺疾病比例逐年顯著略增。
結論:於研究期間,低出生體重早產兒的死亡率顯著下滑,尤其是超低出生體重早產兒,但相對的新生兒各系統之併發症發生率有略增趨勢。
Objectives: This was a prime study in trends in neonatal morbidity and mortality for low birth weight preterm infants.
Methods: We included infants who were born between 1996 and 2005 with birth weight 500-2500g and admitted to the neonatal intensive care unit in Chang-Gung Children’s Hospital.
Results: A total of 5065 low birth weight preterm infants were enrolled in this study. Mortality decreased from 12.09% in 1996 to 4.39% in 2005. In particular, the mortality of extremely low birth weight (<1000g) infants decreased significantly. The independent risk factors of mortality were low gestational age, low birth weight, Apgar score at l and 5 min lower than 3, male, resuscitation in the delivery room, persistent pulmonary (PPHN). The rates of retinopathy of prematurity (ROP) and intraventricular hemorrhage (IVH) did not change significantly, whereas the rate of severe ROP and severe IVH increased slightly from 2001 to 2005. The rate of respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), bronchopulmonary dysplasia (BPD) increased significantly from 1996 to 2005.
Conclusions: There have been some significant decreases in mortality for low birth weight preterm infants from 1996 to 2005, in particular extremely low birth weight preterm infants. But the rates of some complications increased.
指導教授推薦書……………………………………………………
口試委員會審定書…………………………………………………
誌謝 .........................................iv
中文摘要 ..........................................v
圖表目錄 .........................................ix
第一章 緒論 ....................................... - 1 -
第一節 研究背景與動機 .............................. - 1 -
第二節 研究目的 ................................. - 3 -
第二章 文獻探討 ................................. - 4 -
第一節 名詞解釋 ................................. - 4 -
第二節 低出生體重早產兒之死亡率及其相關因素探討 ........- 6 -
第三節 低出生體重早產兒之罹病率及其相關因素探討 ........- 11 -
第四節 低出生體重早產兒罹病與死亡之長期趨勢 ..........- 16 -
第五節 文獻小結 ................................ - 20 -
第三章 研究方法 .................................- 21 -
第一節 研究材料 .................................- 21 -
第二節 研究對象 .................................- 21 -
第三節 研究變項定義 ...............................- 22 -
第四節 資料處理與分析 ...............................- 25 -
第四章 研究結果 .................................- 26 -
第一節 低出生體重早產兒特性、死亡率、罹病率之描述性 ...... - 26 -
第二節 低出生體重早產兒之死亡率及其相關因素探討 ..........- 33 -
第三節 低出生體重早產兒之罹病率及其相關因素探討 ...... - 37 -
第五章 研究討論 .................................- 46 -
第一節 低出生體重早產兒之死亡與罹病趨勢探討 ..........- 46 -
第二節 低出生體重早產兒死亡相關因素之探討 .............- 51 -
第三節 低出生體重早產兒罹病相關因素之探討 .............- 53 -
第四節 研究限制 .................................- 58 -
第六章 結論與建議...................................- 59 -
1. 行政院衛生署:歷年新生兒、嬰兒及孕產婦死亡概況,2007。Available from: http://www.doh.gov.tw/statistic/data/衛生統計叢書2/95/上冊/index.htm
2. Tsou KI, Tsao PN. The morbidity and survival of very-low-birth-weight Infants in Taiwan. Acta Paediatr Tw 2003; 44(6): 349-55.
3. 行政院衛生署: 95年衛生統計系列(六)衛生統計動向,2008。Available from: http://www.doh.gov.tw/statistic/data/衛生動向/95/95htm
4. 李佩珍、郭素珍、鄧森文、呂宗學、李中一:台灣地區嬰兒出生體重與妊娠週數分布之長期變化趨勢。台灣衛誌 2003;22(5):376-85。
5. 財團法人中華民國早產兒基金會:認識早產。Available from: http://www.pbf.org.tw/
6. Tsao PN, Wu TJ, Teng RJ, Tang JR, Tsou Yau KI. Comparison of the outcome of extremely-low-birth-weight infants between two periods. Acta Paediatr Sin 1998 ; 39(4): 233-6.
7. Stillman AL, Horbar JD, Badger GJ, et al. Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics 2002; 110(1): 143-51.
8. 翁新惠、楊長興:低體重早產兒的住院醫療資源耗用分析。台灣衛誌 2002;21(6):397-402。
9. Chang SC, Lin CH, Lin YJ, Yeh TF. Mortality, morbidity, length and cost of hospitalization in very-low-birth-weight infants in the era of National Health Insurance in Taiwan: A medical center's experience. Acta Paediatr Tw 2000; 41(6): 308-12.
10. 陳泰安:台灣地區早產與低出生體重嬰兒死亡趨勢分析。高雄:高雄醫學大學公共衛生學研究所碩士論文,2005。
11. Kusuda S, Fujimura M, Sakuma I, et al. Morbidity and mortality of infants with very low birth weight in Japan: Center variation. Pediatrics 2006; 118(4):1130-8.
12. WHO. Low-birthweight newborns (percentage). Available from: http://www.who.int/whosis/indicators/2007LBW/en/. Accessed May 1, 2008.
13. WHO. Neonatal mortality rate (per 1000 live births).Available from: http://www.who.int/whosis/indicators/2007MortNeoBoth/en/. Accessed May 1, 2008.
14. 謝武勳:認識高危險群新生兒。台大醫網 2005:28-30。
15. Lee YS, Chou YH. Survey of care environment and mortality in a tertiary Neonatal intensive care unit. Clinical Neonatology 2005; 12(2): 55-9.
16. Lin CS, Kao HA, Huang FY, Ho MY, Hsu CH, Huang HY. Clinical study of infants with birth weight less than 1500 grams. Acta Paediatr Sin 1993; 34(5): 372-8.
17. Tsao LY, Chen SN, Chang BL, Chaou WJ. Neonatal mortality and morbidity in a neonatal unit: impact of improved perinatal care in recent 10 years. Acta Paediatr Sin 1995; 36(6): 405-10.
18. Wang TS, Chen H, Tsao LY. Morbidity and mortality among very low birth weight neonates in a neonatal intensive care unit. Clinical Neonatology 2003; 10(2): 63-9.
19. Tsou Yau KI, Hsu CH. Factors affecting the mortality of sick newborns admitted to intensive care units. Acta Paediatr Sin 1999; 40(2): 75-82.
20. Tsou KI, Chua VV, Sy L. Morbidity and mortality of low birth weight infants. Acta Paediatr Sin 1986; 27(3): 251-9.
21. Abdel-Latif ME, Bajuk B, Oei J, Lui K. Mortality and morbidities among very premature infants admitted after hours in an Australian neonatal intensive care unit network. Pediatrics 2006; 117(5): 1632-9.
22. Markestad T, Kaaresen PI, Ronnestad A, et al. Early death, morbidity, and need of treatment among extremely premature infants. Pediatrics 2005; 115(5): 1289-98.
23. Wang PW, Fang LJ, Tsou KI. Factors Affecting the Growth of Very Low Birth Weight Infants at the Corrected Age of 2 Years in Taiwan. Clinical Neonatology 2003; 10(2): 70-5.
24. 林金定、陳麗美:台灣地區低出生體重兒之發生率及其危險因子之研究。公共衛生 1995;21(4):255-67。
25. Rubaltelli FF, Bonafe L, Tangucci M, Spagnolo A, Dani C. Epidemiology of neonatal acute respiratory disorders. Biol Neonate 1998; 74: 7-15.
26. Dani C, Reali MF, Bertini G, et al. Risk factors for the development of respiratory distress syndrome and transient tachypnoea in newborn infants. Eur Respir J 1999; 14: 155-9.
27. Quinn D, Cooper B, Clyman R. Factors associated with permanent closure of the ductus arteriosus: a role for prolonged indomethacin therapy. Pediatrics 2002; 110(1): e10.
28. Agarwal R, Deorari A, Paul V. Patent ductus arteriosus in preterm neonates. Indian J Pediatr 2008; 75(3): 277-80.
29. Yang CS, Chen SJ, Lee FL, Hsu WM, Liu JH. Retinopathy of prematurity: Screening, incidence and risk factors analysis. Chinese Medical Journal (Taipei) 2001; 64(12): 706-12.
30. Akkoyun I, Oto S, Yilmaz G, et al. Risk factors in the development of mild and severe retinopathy of prematurity. J AAPOS 2006; 10: 449-53.
31. Tai PY, Hsu CH, Kao HA, et al. Risk factors for chronic lung disease in very low birth weight infants: a five-year multicenter study in Taiwan. Clinical Neonatology 2005; 12:13-8.
32. Hentschel J, Berger TM, Tschopp A, et al. Population-based study of bronchopulmonary dysplasia in very low birth weight infants in Switzerland. Eur J Pediatr 2005; 164: 292-7.
33. Mancini MC, Barbosa NE, Banwart D, Silveira S, Guerpelli JL, Leone CR. Intraventricular hemorrhage in very low birth weight infants: associated risk factors and outcome in the neonatal period. Rev Hosp Clin Fac Med S Paulo 1999; 54(5): 151-4.
34. Linder N, Haskin O, Levit O, et al. Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study. Pediatrics 2003; 111(5 Pt 1).
35. Koksal N, Baytan B, Bayram Y, Nacarkucuk E. Risk factors for intraventricular haemorrhage in very low birth weight infants. Indian J Pediatr 2002; 69(7): 561-4.
36. Chen PC, Wang PW, Fang LJ. Prognostic predictors of neurodevelopmental outcome or mortality in very-low-birth-weight infants. Acta Paediatr Tw 2005; 46(4):196-200.
37. Chien LY, Whyte R, Aziz K, Thiessen P, Matthew D, Lee SK. Improved outcome of preterm infants when delivered in tertiary care centers. Obstetrics and Gynecology 2001; 98(2): 247-52.
38. Kaiser JR, Tilford JM, Simpson PM, Salhab WA, Rosenfeld CR. Hospital survival of very-low-birth-weight neonates from 1977 to 2000. J Perinatol 2004; 24(6): 343-50.
39. Tommiska V, Heinonen K, Lehtonen L, et al. No improvement in outcome of nationwide extremely low birth weight infant populations between 1996-1997 and 1999-2000. Pediatrics 2007; 119(1): 29-36.
40. Fanaroff AA, Stoll BJ, Wright LL, et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196(2): 147e1-8.
41. Hsieh TT, Hsu JJ, Chen CJ, et al. Analysis of birth weight and gestational age in Taiwan. Journal of the Formosan Medical Association Taiwan 1991; 90(4): 382-7.
42. Shekhawat P, Fong L, Mitvalsky J. Spectrum of clinical and cardiac dysfunction in bronchopulmonary dysplasia: Early prediction of long-term morbidity. J Perinatol 1997; 17: 95-100.
43. Usher R, Allen A, McLean F. Risk of respiratory distress syndrome related to gestational age, route of delivery, and maternal diabetes. Am J Obstet Gynecol 1971; 111: 826-32.
44. Zilberberg MD, Carter C, Lefebvre P, et al. Red blood cell transfusions and the risk of acute respiratory distress syndrome among the critically ill: a cohort study. Critical care (London, England) 2007; 11(3): R63.
45. Riskin A, Riskin-Mashiah S, Lusky A, Reichman B. The relationship between delivery mode and mortality in very low birthweight singleton vertex-presenting infants. BJOG 2004; 111(12): 1365-71.
46. Cibils L, Karrison T, Brown L. Factors influencing neonatal outcomes in the very-low-birth-weight fetus (< 1500 grams) with a breech presentation. Am J Obstet Gynecol 1994; 171(1): 35-42.
47. Fortes Filoho J, Fortes Filoho JB,Eckert GU, Procianoy L, Barros CK, Procianoy RS. Incidence and risk factors for retinopathy of prematurity in very low and in extremely low birth weight infants in a unit-based approach in southern Brazil. Eye 2007; 10.1038: 1-9.
48. Teng RJ, Wu TJ, Tsou Yau KI. Retinopathy of prematurity in very low birthweight neonates: Epidemiology and risk factors. Acta Paed Sin 1997; 38: 370-4.
49. Egreteau L, Pauchard JY, Semama DS, et al. Chronic oxygen dependency in infants born at less than 32 weeks' gestation: incidence and risk factors. Pediatrics 2001; 108(2): e26.
50. Khodapanahandeh F, Khosravi N, Larijani T. Risk fators for intraventricular hemorrhae in very low birth weight infants. Iran J Ped 2007; 17(2): 101-7.
51. Marshall DD, Kotelchuck M, Young TS, et al. Risk factors for chronic lung disease in the surfactant era: A north Carolina population-based study of very birth weight infants. Pediatrics 1999; 104(6): 1345-50.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔