目的 探讨超早产儿的救治情况。 方法 回顾性分析郑州大学第三附属医院新生儿重症监护室2016年1月—2022年12月收治的超早产儿临床资料。将入组的早产儿分为非院内死亡组和存活组，采用SPSS 29.0进行数据分析。 结果 共纳入超早产儿422例，其中非院内死亡组155例，存活组267例。非院内死亡组胎龄、出生体重、剖宫产率、母亲胎膜早破>18 h比例均低于存活组，而Apgar 1 min评分≤3分、气管插管、新生儿呼吸窘迫综合征、早发型败血症、脑室周围-脑室内出血（Ⅲ~Ⅳ级）、肺出血等发生比例高于存活组，差异均有统计学意义（P<0.05）。 结论 胎龄小、出生体重低、出生窒息病史及严重颅内出血、肺出血是导致超早产儿发生非院内死亡的主要原因，因此需做好围产期保健，减少窒息、严重疾病的发生。
Abstract
Objective To study the treatment outcomes of extremely preterm infants. Methods A retrospective analysis was performed for the clinical data of extremely preterm infants who were admitted to the neonatal intensive care unit of the Third Affiliated Hospital of Zhengzhou University from January 2016 to December 2022. The infants were divided into a non-in-hospital death group and a survival group. SPSS 29.0 was used for data analysis. Results A total of 422 extremely preterm infants were included, of which 155 were in the non-in-hospital death group and 267 in the survival group. The gestational age, birth weight, cesarean section rate, and proportion of mothers with premature rupture of membranes >18 hours in the non-in-hospital death group were all lower than those in the survival group (P<0.05). In contrast, the proportions of Apgar score ≤3 at 1 minute, intubation, neonatal respiratory distress syndrome, early-onset sepsis, periventricular-intraventricular hemorrhage (grades III-IV), and pneumorrhagia were higher in the non-in-hospital death group compared to the survival group (P<0.05). Conclusions Low gestational age, low birth weight, the history of birth asphyxia, severe intracranial hemorrhage, and pneumorrhagia may be the main causes of non-in-hospital death in extremely preterm infants, and therefore, perinatal health care should be enhanced to reduce the onset of asphyxia and severe diseases.
关键词
胎龄 /
治疗 /
超早产儿
Key words
Gestational age /
Treatment /
Extremely preterm infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Kaempf J, Morris M, Steffen E, et al. Continued improvement in morbidity reduction in extremely premature infants[J]. Arch Dis Child Fetal Neonatal Ed, 2021, 106(3): 265-270. PMID: 33109606. DOI: 10.1136/archdischild-2020-319961.
2 Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012[J]. JAMA, 2015, 314(10): 1039-1051. PMID: 26348753. PMCID: PMC4787615. DOI: 10.1001/jama.2015.10244.
3 Humberg A, H?rtel C, Rausch TK, et al. Active perinatal care of preterm infants in the German neonatal network[J]. Arch Dis Child Fetal Neonatal Ed, 2020, 105(2): 190-195. PMID: 31248963. DOI: 10.1136/archdischild-2018-316770.
4 Hossain S, Shah PS, Ye XY, et al. Outcome comparison of very preterm infants cared for in the neonatal intensive care units in Australia and New Zealand and in Canada[J]. J Paediatr Child Health, 2015, 51(9): 881-888. PMID: 25808827. DOI: 10.1111/jpc.12863.
5 Isayama T. The clinical management and outcomes of extremely preterm infants in Japan: past, present, and future[J]. Transl Pediatr, 2019, 8(3): 199-211. PMID: 31413954. PMCID: PMC6675688. DOI: 10.21037/tp.2019.07.10.
6 Qiao J, Wang Y, Li X, et al. A lancet commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China[J]. Lancet (London, England), 2021, 397(10293): 2497-2536. PMID: 34043953. DOI:10.1016/S0140-6736(20)32708-2.
7 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M].5版.北京: 人民卫生出版社, 2019.
8 中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识（2019年版）[J]. 中华儿科杂志, 2019, 57(4): 252-257. PMID: 30934196. DOI: 10.3760/cma.j.issn.0578-1310.2019.04.005
9 谢幸, 苟文丽. 妇产科学[M]. 9版.北京: 人民卫生出版社, 2018.
10 Leuthner SR. Borderline viability: controversies in caring for the extremely premature infant[J]. Clin Perinatol, 2014, 41(4): 799-814. PMID: 25459775. DOI: 10.1016/j.clp.2014.08.005.
11 多中心极低和超低出生体重儿的预后评估协作组. 超早产儿和超低出生体重儿的死亡原因: 多中心前瞻性队列研究[J]. 中华围产医学杂志, 2020, 23(8): 530-538. DOI: 10.3760/cma.j.cn113903-20191221-00725.
12 赵小林, 张勤, 姜泓, 等. 超早产儿及超低出生体质量儿临床分析[J]. 中华实用儿科临床杂志, 2020, 35(19): 1480-1484. DOI: 10.3760/cma.j.cn101070-20190818-00760.
13 Boghossian NS, Geraci M, Edwards EM, et al. Regional and racial-ethnic differences in perinatal interventions among periviable births[J]. Obstet Gynecol, 2020, 135(4): 885-895. PMID: 32168210. PMCID: PMC7103505. DOI: 10.1097/AOG.0000000000003747.
14 蒋思远, 杨传忠, 田秀英, 等. 中国新生儿协作网出生胎龄22~25周超早产儿出院预后及治疗现状[J]. 中华儿科杂志, 2024, 62(1): 22-28. DOI: 10.3760/cma.j.cn112140-20231017-00296.
15 Venkatesh KK, Lynch CD, Costantine MM, et al. Trends in active treatment of live-born neonates between 22 weeks 0 days and 25 weeks 6 days by gestational age and maternal race and ethnicity in the US, 2014 to 2020[J]. JAMA, 2022, 328(7): 652-662. PMID: 35972487. PMCID: PMC9382444. DOI: 10.1001/jama.2022.12841.
16 Zhu Z, Yuan L, Wang J, et al. Mortality and morbidity of infants born extremely preterm at tertiary medical centers in China from 2010 to 2019[J]. JAMA Netw Open, 2021, 4(5): e219382. PMID: 33974055. PMCID: PMC8114138. DOI: 10.1001/jamanetworkopen.2021.9382.
17 中华医学会围产医学分会, 中国医师协会新生儿科医师分会. 关于超早产儿救治的出生胎龄低限和分娩场所的建议[J]. 中华围产医学杂志, 2022, 25(2): 88-91. DOI: 10.3760/cma.j.cn113903-20211123-00973.
18 Gkiougki E, Chatziioannidis I, Pouliakis A, et al. Periviable birth: a review of ethical considerations[J]. Hippokratia, 2021, 25(1): 1-7. PMID: 35221649. PMCID: PMC8877922.
19 Ceriani Cernadas JM. The limits of viability in preterm infants, a growing ethical dilemma[J]. Arch Argent Pediatr, 2018, 116(3): 170-171. PMID: 29756699. DOI: 10.5546/aap.2018.eng.170.
20 Dahan S, Jung C, Dassieu G, et al. Trust and consent: a prospective study on parents' perspective during a neonatal trial[J]. J Med Ethics, 2021, 47(10): 678-683. PMID: 32079742. DOI: 10.1136/medethics-2019-105597.
21 Green J, Darbyshire P, Adams A, et al. Neonatal nurses' response to a hypothetical premature birth situation: what if it was my baby?[J]. Nurs Ethics, 2018, 25(7): 880-896. PMID: 27940925. DOI: 10.1177/0969733016677871.
22 Hendriks MJ, Lantos JD. Fragile lives with fragile rights: justice for babies born at the limit of viability[J]. Bioethics, 2018, 32(3): 205-214. PMID: 29369374. DOI: 10.1111/bioe.12428.
基金
河南省医学科技攻关联合共建项目（LHGJ20220540）。
PDF(543 KB)
