摘要
目的总结本单位32例≤23周生存极限超早产儿(periviable extremely preterm infant,PEPI)的存活率、并发症发生及预后情况。方法回顾性分析2015年1月1日至2021年12月31日深圳市妇幼保健院新生儿重症监护病房收治的胎龄≤23周的PEPI的资料,比较2015年至2019年与2020年至2021年收治患儿的结局和随访情况。采用χ^(2)检验(或Fisher精确概率法)进行统计学分析。结果(1)研究期间共收治32例PEPI,占同期本单位出生活产新生儿的0.024%(32/132534)。32例PEPI出生胎龄[M(min~max)]为23周(21周^(+4)~23周^(+6));出生体重480 g(350~720 g)。(2)2020年至2021年PEPI存活率为10/19,显现出高于2015年至2019年(3/13)的趋势,但差异未见有统计学意义(χ^(2)=2.79,P=0.095);2020年至2021年放弃治疗率为3/19,低于2015年至2019年的8/13(χ^(2)=7.16,P=0.007)。(3)32例患儿中,13例(40.6%)存活至出院。这13例中,4例出生胎龄为22周,9例为23周;出生体重300~<400 g、400~<500 g、500~<600 g、600~<700 g和≥700 g者分别为1、5、4、1和2例。(4)存活至出院的13例患儿并发症发生率依次为中-重度支气管肺发育不良(10/13),需手术干预的ROP(5/13),需手术治疗的动脉导管未闭(4/13),以及晚发型败血症、≥Ⅱa期坏死性小肠结肠炎、Ⅲ~Ⅳ级脑室内出血及脑室周围白质软化(均为2/13)。13例患儿随访了10个月(6~69个月),其中3例发生运动发育迟缓。结论本中心收治的PEPI总体救治存活率较高,住院期间并发症较低,预后相对较好。这些PEPI的远期预后需要进一步随访。
Objective To summarize the survival rate,complications,and outcomes of 32 periviable extremely preterm infants(PEPIs)born at≤23 gestational weeks.Methods This was a retrospective observational study involving PEPIs born at the Shenzhen Maternity&Child Healthcare Hospital from January 1,2015,to December 31,2021.Clinical data of all subjects were collected and analyzed.The survival rates of PEPIs born from 2015 to 2019 and 2020 to 2021 were compared.Chi-square(or Fisher's exact)test was used for statistical analysis.Results(1)During the study period,32 PEPIs were admitted,accounting for 0.024%(32/132534)of all newborns born in the same hospital during the study period.The median gestational age of the 32 PEPIs was 23 weeks(21^(+4)-23^(+6) weeks),and the birth weight was 480 g(350-720 g).(2)The survival rate of PEPIs born between 2020 and 2021 was 10/19,which appears to be a trend higher than that between 2015 and 2019(3/13,χ^(2)=2.79,P=0.095),while the rate of withdrawal of treatment was 8/13 and 3/19,respectively,with a statistically significant difference(χ^(2)=7.16,P=0.007).(3)Thirteen of the 32 PEPIs survived on discharge,including four born at 22 weeks and nine at 23 weeks.The birth weights of these surviving infants were 300-<400 g in one case,400-<500 g in five cases,500-<600 g in four cases,600-<700 g in one case,and≥700 g in two cases.(4)The most common complication was moderate and severe bronchopulmonary dysplasia(10/13),followed by retinopathy of prematurity requiring surgical intervention(5/13),patent ductus arteriosus requiring ligation(4/13),late-onset sepsis(2/13),necrotizing enterocolitis(stageⅡa or above)(2/13)and gradeⅢ-Ⅳintraventricular hemorrhage or periventricular leukomalacia(2/13).The median duration of follow-up was ten months(6-69 months),and motor retardation occurred in three infants.Conclusions The overall survival rate of PEPIs in our hospital is relatively high,with a lower incidence of complications during hospitalization and relatively better outcome.However,further stud
作者
陈春
黄智峰
熊小云
赵捷
孙红岩
王美琪
杨传忠
Chen Chun;Huang Zhifeng;Xiong Xiaoyun;Zhao Jie;Sun Hongyan;Wang Meiqi;Yang Chuanzhong(Department of Neonatology,Shenzhen Maternity&Child Healthcare Hospital Affiliated to Southern Medical University,Shenzhen 518028,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2023年第5期391-397,共7页
Chinese Journal of Perinatal Medicine
基金
广东省高水平临床重点专科(深圳市配套建设经费)(SZGSP009)。
关键词
婴儿
极度早产
存活率
死亡率
重症监护病房
新生儿
预后
Infant,extremely premature
Survival rate
Mortality
Intensive care units,neonatal
Prognosis
