Improving Survival of Extremely Preterm Infants Born Between 22 and 25 Weeks of Gestation
Improving Survival of Extremely Preterm Infants Born Between 22 and 25 Weeks of Gestation
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DOI：
10.1097/aog.0b013e31824b1a03
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发表时间：
2012-04-01
影响因子：
7.2
通讯作者：
Dagle, John M.
中科院分区：
文献类型：
--
作者：
Kyser, Kathy L.;Morriss, Frank H., Jr.;Dagle, John M.
目的：估计2000-2009年出生的极早产儿的观察存活率与预测存活率的比较，以确定存活率的当代预测因素，并确定在这十年中存活率是否有所提高。方法：我们对2000年至2009年出生的237名无重大先天性畸形的新生儿进行了回顾性队列分析，这些新生儿在完成22至25周的治疗后出生。怀孕将每个胎龄观察到的生存率与基于胎龄、出生体重、性别、单胎或多胎妊娠以及产前皮质类固醇给药的预测生存率进行比较，该预测生存率通过基于网络的计算器估计，该计算器来自1998年至2003年的大型国家队列结果。多变量逻辑回归分析用于确定研究队列生存率的重要预测因素，包括出生年份。（与预测率相比）为：22周，33%（与19%相比）; 23周，58%（与38%相比）; 24周，87%（与58%相比）; 25周，85%（与70%相比）。在96%的妊娠中使用了产前皮质类固醇。显著预测生存率的变量及其比值比（OR）和95%置信区间（CI）为：（OR 5.27，CI 1.26-22.08）;女性（OR 3.21，CI 1.42-7.26）、胎龄（OR 1.89，CI 1.27-2.81）、1分钟Apgar评分（OR 1.39，CI 1.15-1.69）和出生年份（OR 1.17，CI 1.02-1.34）。为预防一例死亡，产前皮质类固醇治疗所需的人数为2.4人。在这个单一机构队列中，（产前皮质类固醇给药[即使少于24周]，安胎直至类固醇疗程结束，因胎儿窘迫而剖宫产），在2000年代，怀孕22-25周的新生儿存活率超过了预测的存活率，在这十年中存活几率增加。围手术期给予皮质类固醇对生存率有显著影响。（妇产科2012;119：795-800）DOI：10.1097/AOG.0b013e31824b1a03
OBJECTIVE: To estimate observed compared with predicted survival rates of extremely premature infants born during 2000-2009, to identify contemporary predictors of survival, and to determine if improved survival rates occurred during the decade.METHODS: We conducted a retrospective cohort analysis of 237 inborn neonates without major congenital anomalies born from 2000 to 2009 after 22 to 25 completed weeks of gestation. Observed survival rates at each gestational age were compared with predicted survival rates based on gestational age, birth weight, sex, singleton or multiple gestation, and antenatal corticosteroid administration estimated by a Web-based calculator that was derived from 1998 to 2003 outcomes of a large national cohort. Multivariable logistic regression analysis was used to identify significant predictors of survival of the study cohort, including year of birth.RESULTS: Survival rates for the decade by gestational age (compared with predicted rates) were: 22 weeks, 33% (compared with 19%); 23 weeks, 58% (compared with 38%); 24 weeks, 87% (compared with 58%); and 25 weeks, 85% (compared with 70%). Antenatal corticosteroids were administered in 96% of pregnancies. Variables that significantly predicted survival and their odds ratios (OR) with 95% confidence intervals (CI) are: antenatal corticosteroid administration (OR 5.27, CI 1.26-22.08); female sex (OR 3.21, CI 1.42-7.26); gestational age (OR 1.89, CI 1.27-2.81); 1-minute Apgar score (OR 1.39, CI 1.15-1.69); and birth year (OR 1.17, CI 1.02-1.34). The number needed to treat with any antenatal corticosteroid therapy to prevent one death was 2.4.CONCLUSION: In this single-institution cohort treated aggressively (antenatal corticosteroid administration [even if less than 24 weeks], tocolysis until steroid course complete, cesarean for fetal distress) by perinatologists and neonatologists, survival rates at 22-25 weeks of gestation age for inborn infants during the 2000s exceeded predicted rates, with increasing odds of survival during the decade. Antenatal corticosteroid administration had a significant effect on survival. (Obstet Gynecol 2012;119:795-800) DOI: 10.1097/AOG.0b013e31824b1a03