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.
Key words
Gestational age /
Treatment /
Extremely preterm infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
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.
PDF(543 KB)
