Two-Year Neurodevelopmental Outcome of an Infant Born at 21 Weeks' 4 Days' Gestation.
Two-Year Neurodevelopmental Outcome of an Infant Born at 21 Weeks' 4 Days' Gestation.
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DOI：
10.1542/peds.2017-0103
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发表时间：
2017-12
期刊：
影响因子：
8
通讯作者：
Placencia FX
中科院分区：
文献类型：
--
作者：
Ahmad KA;Frey CS;Fierro MA;Kenton AB;Placencia FX
最近的文献证实，在宫外存活率下限，复苏实践中存在显着的中心间变异性。这种差异的原因尚不清楚，但可能与如何将最佳利益标准应用于极早产儿的分歧有关。目前，产科和儿科协会均建议不要在妊娠 22 周之前评估生存能力或尝试复苏。在这种情况下，我们报告了一名女婴在妊娠 21 周第 4 天、出生体重 410 克时复苏后的 2 年结果，未受影响。她可能是迄今为止已知的最早产的幸存者。该婴儿有多种导致不良结果的危险因素，包括机械通气时间延长、支气管肺发育不良和早产儿视网膜病变。她在妊娠 39 周 4 天、体重 2519 克时靠低流量吸氧出院。在 24 个月零 8 天的实际年龄时，她的认知、运动和语言 Bayley III 评分分别为 90、89 和 88，相当于 20 个月零 2 天的校正年龄时的 105、100 和 103。众所周知，妊娠 22 周时的积极干预政策可以改善这些婴儿的结局，并且可以合理地推断，这些益处将延续到第 21 周（如果程度较轻）。最终，这个胎龄的数据如此有限，以至于产科中心可能已经到了在第 21 周开始系统报告胎儿结局的时候了。
Recent literature confirms that, at the lower limit of extrauterine survival, substantial intercenter variability exists in resuscitation practice. The reasons for this variability are unclear, but may be related to disagreement on how to apply the best interests standard to extremely premature infants. Currently, both obstetric and pediatric societies recommend against assessing for viability or attempting resuscitation before 22 weeks’ gestation. In this context, we report the unimpaired 2-year outcome of a female infant resuscitated after delivery at 21 weeks’ 4 days’ gestation and 410 g birth weight. She may be the most premature known survivor to date. This infant had multiple risk factors for adverse outcome, including prolonged mechanical ventilation, bronchopulmonary dysplasia, and threshold retinopathy of prematurity. She achieved discharge from the hospital on low-flow oxygen at 39 weeks’ 4 days’ gestation and 2519 g. At 24 months’ and 8 days’ chronological age, she achieved cognitive, motor, and language Bayley III scores of 90, 89, and 88, equivalent to 105, 100, and 103 at 20 months 2 days corrected age. It is known that active intervention policies at 22 weeks’ gestation improves the outcome for those infants and it may be reasonable to infer that these benefits would extend, if to a lesser degree, into the 21st week. Ultimately, such limited data exist at this gestational age that the time may have arrived for obstetrical centers to begin systematically reporting fetal outcomes in the 21st week.
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影响因子：
2.4
作者：
Fenton TR;Kim JH
通讯作者：
Kim JH
影响因子：
158.5
作者：
KOPELMAN, LM;IRONS, TG;KOPELMAN, AE
通讯作者：
KOPELMAN, AE
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影响因子：
2.9
作者：
Placencia, F. X.;Ahmadi, Y.;McCullough, L. B.
通讯作者：
McCullough, L. B.
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158.5
作者：
Rysavy, Matthew A.;Li, Lei;Higgins, Rosemary D.
通讯作者：
Higgins, Rosemary D.