Survival and neurodevelopmental outcome of preterm infants born at 22-24 weeks of gestational age.
Survival and neurodevelopmental outcome of preterm infants born at 22-24 weeks of gestational age.
复制标题
胎龄 22-24 周出生的早产儿的生存和神经发育结果。
作者：
Ochiai M;Kinjo T;Takahata Y;Iwayama M;Abe T;Ihara K;Ohga S;Fukushima K;Kato K;Taguchi T;Hara T
背景：极早产儿的生存能力限制对发达国家的任何儿科医生都具有挑战性。在新生儿重症监护室的管理下，极早产儿的神经系统发育和生长已经成为一个新出现的问题。Objective：To assess potential associations between changes in practice and survival/neurodevelopmental outcome，and clinical outcomes of extremely preterm infants born at the limit of viability studied in a tertiary center.Study Design：一项回顾性研究纳入了51名无先天性疾病的婴儿，出生于2000-2009年的胎龄（GA）22-24周。结果：2005-2009年出生的24名早产儿的一年生存率（79%）高于2000-2004年出生的27名婴儿（52%，p = 0.04）。与2004年之前出生的婴儿相比，2005年之后出生的婴儿接受安胎治疗的次数较少（54%对94%，p < 0.01），产前类固醇治疗的频率更高（32%对6%，p = 0.01）。2005年后的幸存者（n = 19）比2004年前的幸存者（n = 14）更频繁地接受吲哚美辛治疗（89 vs. 50%，p = 0.03）和早期肠外营养（95 vs. 36%，p < 0.01）。在2004年之前（9/13，69%）和2005年之后（10/17，59%）的3岁时DQ>50的婴儿比例没有差异。多因素分析表明，极早产在GA <24 weeks was the sole critical factor for a DQ of >50在survival.Conclusions：2005年后的围产期护理提高了总生存率，但没有早产幸存者的神经功能的结果在生存能力的极限。神经发育障碍与GA <24周的极早产有关。
Background:The limits of viability in extremely premature infants are challenging for any neonatologists in developed countries. The neurological development and growth of extremely preterm infants have come to be the emerging issue following the management in the neonatal intensive care unit.Objective:To assess potential associations between changes in practice and survival/neurodevelopmental outcome, and clinical outcomes of extremely preterm infants born at the limit of viability studied in a tertiary center.Study Design:A retrospective study enrolled 51 infants who had no congenital disorders, and were born at 22-24 weeks of gestational age (GA) in 2000-2009 in our institution. Clinical variables and interventions were studied with regard to one-year survival and developmental quotient (DQ) at 3 years of age.Results:The one-year survival rate of 24 preterm infants born in 2005-2009 (79%) was higher than that of the 27 infants born in 2000-2004 (52%, p = 0.04). Infants born after 2005 underwent less tocolysis (54 vs. 94%, p < 0.01) and more frequently antenatal steroid therapy (32 vs. 6%, p = 0.01) than those born before 2004. The post-2005 survivors (n = 19) received more frequently indomethacin therapy (89 vs. 50%, p = 0.03) and early parenteral nutrition (95 vs. 36%, p < 0.01) than the pre-2004 survivors (n = 14). There were no differences in the proportion of infants who attained a DQ of >50 at 3 years of age between pre-2004 (9/13, 69%) and post-2005 groups (10/17, 59%). Multivariate analysis indicated that extremely premature birth at GA <24 weeks was the sole critical factor for a DQ of >50 in survivors.Conclusions:The perinatal care after 2005 improved the overall survival rate, but not the neurological outcome of preterm survivors at the limit of viability. Neurodevelopmental impairments were associated with extremely premature birth at GA <24 weeks.