Outcome at 5 years of age of children 23 to 27 weeks' gestation: Refining the prognosis
Outcome at 5 years of age of children 23 to 27 weeks' gestation: Refining the prognosis
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DOI：
10.1542/peds.108.1.134
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发表时间：
2001-07-01
期刊：
影响因子：
8
通讯作者：
Doyle, LW
中科院分区：
文献类型：
--
作者：
Doyle, LW
目标。确定极早产儿至 5 岁的生存率随出生后年龄的变化（无论有无严重的感音神经障碍），并将其预后与正常出生体重 (NBW) 对照参与者进行对比。方法。在澳大利亚维多利亚州进行了一项地理确定的队列研究。对 1991 年至 1992 年出生的连续 23 至 27 周胎龄的活产婴儿和随机选择的同期 NBW 对照参与者进行了研究。主要结局指标是 5 岁时的生存率和严重残疾率，针对接受重症监护的患者、第 7 天后、第 28 天后以及出院时确定。结果。在 401 名妊娠 23 至 27 周的活产婴儿中，225 名（56.1%）存活至 5 岁。对于那些接受重症监护的患者，存活率随着出生时胎龄的增加而显着上升，到第 7 天但到第 28 天则不然。随着所有产后年龄的胎龄增加，无严重残疾的存活率显着上升，但到第 28 天并不是一个独立的预测变量；其他不良事件更为重要。在没有不良事件的情况下，存活到出院的极早产儿的无严重残疾的存活率为 93.2%，与 NBW 对照参与者的 95.5% 相似。结论。极早产儿的预后随出生后年龄的不同而发生很大变化。应定期重复对家庭进行咨询，所提供的建议应根据围产期事件而变化。
Objectives. To determine the changes with postnatal age for survival, with and without major sensorineural disability, to 5 years of age in very preterm infants and to contrast their prognosis with normal birth weight (NBW) control participants.Methods. A geographically determined cohort study was conducted in Victoria, Australia. Consecutive live births of 23 to 27 weeks' gestational age born during 1991 to 1992 and randomly selected contemporaneous NBW control participants were studied. The main outcome measures were survival and rates of major disability at 5 years of age, determined for those offered intensive care, after day 7, after day 28, and at hospital discharge.Results. Of 401 live births of 23 to 27 weeks' gestation, 225 (56.1%) survived to 5 years of age. The survival rate rose significantly with increasing gestational age at birth in those offered intensive care and by day 7 but not by day 28. The survival rate free of major disability rose significantly with increasing gestational age at all postnatal ages but was not an independent predictive variable by day 28; other adverse events were more important. In the absence of adverse events, the rate of survival free of major disability for very preterm infants who had survived to discharge was 93.2%, similar to the rate of 95.5% for NBW control participants.Conclusions. The prognosis for very preterm infants changes substantially with postnatal age. Counseling of families should be repeated at intervals, and the advice offered should vary with perinatal events.