One-Year Survival of Extremely Preterm Infants After Active Perinatal Care in Sweden
One-Year Survival of Extremely Preterm Infants After Active Perinatal Care in Sweden
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DOI：
10.1001/jama.2009.771
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发表时间：
2009-06-03
影响因子：
120.7
通讯作者：
Stromberg, Bo
中科院分区：
文献类型：
--
作者：
Blennow, Mats;Ewald, Uwe;Stromberg, Bo
研究背景：评估围产期保健服务、临床指南和家长咨询需要最新的关于极早产婴儿存活率的信息。目的：确定2004- 2007年瑞典27孕周前出生的所有婴儿的1年存活率。极早产儿人群前瞻性观察研究887名母亲在904次分娩中产下707名活产婴儿和304名死胎婴儿2004年4月1日至2005年3月31日，瑞典所有产科和新生儿单位的102例多胞胎，2007.主要指标：婴儿存活至365天，存活期无新生儿主要发病率（脑室内出血> 2级，早产儿视网膜病变> 2期，脑室周围白质软化，坏死性小肠结肠炎，严重支气管肺发育不良）。围产期干预和survival.Results之间的关联极端早产的发病率为3.3每1000名婴儿。总体围产期死亡率为45%（从22周时的93%到26周时的24%），其中30%为死产，包括6.5%的产时死亡。在活产婴儿中，91%进入新生儿重症监护室，70%存活至1岁（95%置信区间[CI]，67%-73%）。第22、23、24、25和26周的Kaplan-Meier生存率估计值为9.8%（95% CI，4%-23%）、53%（95% CI，44%-63%）、67%（95% CI，59%-75%）、82%（95% CI，76%-87%）和85%（95% CI，81%-90%）。婴儿死亡风险较低与保胎治疗有关（校正胎龄比值比[ OR]，0.43; 95% CI，0.36-0.52），产前皮质类固醇（OR，0.44; 95%CI，0.24-0.81），出生后2小时内表面活性剂治疗（OR，0.47; 95%CI，0.32-0.71），在三级医院出生（OR，0.49; 95%CI，0.32-0.75）。在1年的幸存者中，45%没有主要的新生儿morphis.Conclusion在2004年至2007年，1年的生存率在瑞典出生的婴儿活着在22至26周的妊娠是70%，范围从9.8%，在22周至85%，在26周。JAMA. 2009;301（21）：2225-2233 www.jama.com
Context Up-to-date information on infant survival after extremely preterm birth is needed for assessing perinatal care services, clinical guidelines, and parental counseling.Objective To determine the 1-year survival in all infants born before 27 gestational weeks in Sweden during 2004-2007.Design, Setting, and Patients Population-based prospective observational study of extremely preterm infants (707 live-born and 304 stillbirths) born to 887 mothers in 904 deliveries (102 multiple births) in all obstetric and neonatal units in Sweden from April 1, 2004, to March 31, 2007.Main Outcome Measures Infant survival to 365 days and survival without major neonatal morbidity (intraventricular hemorrhage grade > 2, retinopathy of prematurity stage > 2, periventricular leukomalacia, necrotizing enterocolitis, severe bronchopulmonary dysplasia). Associations between perinatal interventions and survival.Results The incidence of extreme prematurity was 3.3 per 1000 infants. Overall perinatal mortality was 45% (from 93% at 22 weeks to 24% at 26 weeks), with 30% stillbirths, including 6.5% intrapartum deaths. Of live-born infants, 91% were admitted to neonatal intensive care and 70% survived to 1 year of age (95% confidence interval [CI], 67%-73%). The Kaplan-Meier survival estimates for 22, 23, 24, 25, and 26 weeks were 9.8% (95% CI, 4%-23%), 53% ( 95% CI, 44%-63%), 67% (95% CI, 59%-75%), 82% (95% CI, 76%-87%), and 85% ( 95% CI, 81%-90%), respectively. Lower risk of infant death was associated with tocolytic treatment (adjusted for gestational age odds ratio [ OR], 0.43; 95% CI, 0.36-0.52), antenatal corticosteroids (OR, 0.44; 95% CI, 0.24-0.81), surfactant treatment within 2 hours after birth ( OR, 0.47; 95% CI, 0.32-0.71), and birth at a level III hospital (OR, 0.49; 95% CI, 0.32-0.75). Among 1-year survivors, 45% had no major neonatal morbidity.Conclusion During 2004 to 2007, 1-year survival of infants born alive at 22 to 26 weeks of gestation in Sweden was 70% and ranged from 9.8% at 22 weeks to 85% at 26 weeks. JAMA. 2009;301(21):2225-2233 www.jama.com