Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitati...Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable(gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.展开更多
文摘目的探讨超早产儿早期(生后7 d内)死亡的危险因素,并构建早期死亡风险预测模型。方法回顾性选择2017年1月至2022年12月于济宁医学院附属医院产科分娩的胎龄22+0~27周+6的244例超早产儿,根据生后存活是否≥7 d分为早期存活组(n=140)和早期死亡组(n=84)。采用LASSO、logistic回归筛选超早产儿早期死亡的危险因素。应用R软件绘制列线图预测模型。使用拟合优度检验、受试者工作特征曲线下面积(area under the curve,AUC)、校准曲线、决策曲线评估模型的效能和临床实用性。结果LASSO回归、多因素logistic回归分析显示臀位分娩(OR=3.055,95%CI:1.125~8.296)、产房内气管插管(OR=4.320,95%CI:1.328~14.053)、产房内应用肾上腺素(OR=10.706,95%CI:1.454~78.816)、生后6 h内诊断Ⅲ~Ⅳ级新生儿呼吸窘迫综合征(OR=11.552,95%CI:3.056~43.677)是超早产儿早期死亡的危险因素,而出生胎龄大(OR=0.234,95%CI:0.125~0.436)、产前使用糖皮质激素促胎肺成熟(OR=0.046,95%CI:0.014~0.145)和生后6 h内应用肺表面活性物质(OR=0.021,95%CI:0.004~0.122)是超早产儿死亡的保护因素。基于上述7个因素建立的列线图模型拟合优度检验表明拟合良好(P=0.702),预测超早产儿早期死亡的AUC为0.963(95%CI:0.943~0.983),灵敏度为0.904(95%CI:0.806~0.949),特异度为0.892(95%CI:0.829~0.938),准确性为0.880。决策曲线显示阈值概率>2%将产生总体净获益。结论臀位分娩、产房内气管插管、产房内应用肾上腺素、生后6 h内诊断Ⅲ~Ⅳ级新生儿呼吸窘迫综合征为超早产儿早期死亡的独立危险因素,出生胎龄大、孕母产前使用糖皮质激素促胎肺成熟及生后6 h内使用肺表面活性物质为超早产儿早期死亡的保护因素,基于上述因素构建的预测模型能定量、简便、直观地评估超早产儿早期死亡的风险。
文摘Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable(gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.
