非免疫性胎儿水肿新生儿的临床特征及预后分析

Clinical features and prognosis of neonates with nonimmune hydrops fetalis

摘要:

目的 分析非免疫性胎儿水肿（NIHF）新生儿的临床特征、病因及转归情况。方法 回顾性分析23例NIHF新生儿的临床资料及转归。结果 23例NIHF患儿中，早产儿18例（78%），足月儿5例（22%）；出生窒息12例（52%），其中重度窒息6例。NIHF病因包括双胎输血综合征（TTTS）8例（35%），心血管畸形3例（13%），微小病毒B19感染3例（13%），先天性乳糜胸2例（9%），Turner综合征1例（4%），柯萨奇病毒感染1例（4%），病因不明5例（22%）。临床治愈13例（57%），死亡10例，新生儿期病死率为43%。死亡组中早产儿、新生儿窒息、5分钟Apgar评分<8分及心力衰竭比例（分别为100%、100%、60%、60%）明显高于存活组（分别为62%、15%、8%、8%）（P < 0.05）。结论 NIHF新生儿易发生出生窒息；胎龄越小、窒息程度越重、合并心力衰竭者新生儿期死亡风险越大。TTTS中受血儿是NIHF的主要病因。

Abstract:

Objective To study the clinical features, etiology and prognosis of neonates with nonimmune hydrops fetalis (NIHF). Methods A retrospective analysis was performed for the clinical data and outcomes of 23 neonates with NIHF. Results Of the 23 neonates with NIHF, 18 (78%) were preterm infants and 5 (22%) were full-term infants; 12 (52%) had birth asphyxia (including 5 cases of severe asphyxia). As for the causes of NIHF, 8 neonates (35%) had twintwin transfusion syndrome (TTTS), 3 (13%) had cardiovascular malformation, 3 (13%) had parvovirus B19 infection, 2 (9%) had congenital chylothorax, 1 (4%) had Turner syndrome, 1 (4%) had Coxsackie virus infection, and 5 (22%) had unknown etiology. Of the 23 neonates, 13 achieved clinical cure, 10 died, resulting in a neonatal mortality rate of 43%. Compared with the survival group, the death group had a signifcantly higher proportion of preterm infants or infants with asphyxia, 5-minute Apgar score <8 or heart failure (100%/100%/60%/60% vs 62%/15%/8%/8%; P < 0.05). Conclusions Birth asphyxia is common in neonates with NIHF. The neonates with a lower gestational age, a more serious asphyxia or heart failure have a higher risk of death in the neonatal period. Being the recipient of TTTS is a major cause of NIHF.