Intensive care for extreme prematurity - Moving beyond gestational age
Intensive care for extreme prematurity - Moving beyond gestational age
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DOI：
10.1056/nejmoa073059
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发表时间：
2008-04-17
影响因子：
158.5
通讯作者：
Higgins, Rosemary D.
中科院分区：
文献类型：
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作者：
Tyson, Jon E.;Parikh, Nehal A.;Higgins, Rosemary D.
背景：决定是否对极早产儿进行重症监护通常仅基于胎龄。然而，其他因素也影响这些患者的预后。我们前瞻性地研究了4446名在妊娠22至25周出生的婴儿国家儿童健康和人类发展研究所新生儿研究网络的风险评估（根据最佳产科估计确定），将出生时或出生前可评估的风险因素与存活可能性联系起来，无严重神经发育障碍的存活率，以及校正年龄为18至22个月时无神经发育障碍的存活率。结果：在研究婴儿中，3702例（83%）接受了机械通气形式的重症监护。在4192名研究婴儿（94%）中，在18至22个月时确定了结局，49%死亡，61%死亡或有严重损害，73%死亡或有损害。在对接受重症监护的婴儿进行的多变量分析中，产前暴露于皮质类固醇、女性、单胎分娩和较高出生体重（每增加100 g）均与死亡风险和死亡或严重或任何神经发育障碍风险降低相关;这些降低与胎龄增加1周相关。在相同的估计可能性的一个有利的结果，女孩不太可能比男孩接受重症监护。接受通气的婴儿的结果是更好地预测与使用上述因素比单独使用的孕龄。结论：一个有利的结果与重症监护的可能性可以更好地估计考虑四个因素，除了胎龄：性别，暴露或非暴露于产前皮质类固醇，无论是单胎还是多胎，出生体重。（ClinicalTrials.gov编号：NCT 00063063和NCT 00009633）。
Background: Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients.Methods: We prospectively studied a cohort of 4446 infants born at 22 to 25 weeks' gestation (determined on the basis of the best obstetrical estimate) in the Neonatal Research Network of the National Institute of Child Health and Human Development to relate risk factors assessable at or before birth to the likelihood of survival, survival without profound neurodevelopmental impairment, and survival without neurodevelopmental impairment at a corrected age of 18 to 22 months.Results: Among study infants, 3702 (83%) received intensive care in the form of mechanical ventilation. Among the 4192 study infants (94%) for whom outcomes were determined at 18 to 22 months, 49% died, 61% died or had profound impairment, and 73% died or had impairment. In multivariable analyses of infants who received intensive care, exposure to antenatal corticosteroids, female sex, singleton birth, and higher birth weight (per each 100-g increment) were each associated with reductions in the risk of death and the risk of death or profound or any neurodevelopmental impairment; these reductions were similar to those associated with a 1-week increase in gestational age. At the same estimated likelihood of a favorable outcome, girls were less likely than boys to receive intensive care. The outcomes for infants who underwent ventilation were better predicted with the use of the above factors than with use of gestational age alone.Conclusions: The likelihood of a favorable outcome with intensive care can be better estimated by consideration of four factors in addition to gestational age: sex, exposure or nonexposure to antenatal corticosteroids, whether single or multiple birth, and birth weight. (ClinicalTrials.gov numbers, NCT00063063 and NCT00009633.).