Impact of different treatment attitudes on survival and risk factors for poor clinical outcomes in extremely preterm infants: a retrospective real-world study

LI Meng-Meng; LI Shu-Shu; QIAN Miao; ZHANG Min; HAN Shu-Ping

doi:10.7499/j.issn.1008-8830.2410006

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Chinese Journal of Contemporary Pediatrics ›› 2025, Vol. 27 ›› Issue (3) : 269-278. DOI: 10.7499/j.issn.1008-8830.2410006

CLINICAL RESEARCH

Impact of different treatment attitudes on survival and risk factors for poor clinical outcomes in extremely preterm infants: a retrospective real-world study

LI Meng-Meng, LI Shu-Shu, QIAN Miao, ZHANG Min, HAN Shu-Ping

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Abstract

Objective To explore the impact of different treatment attitudes on the survival status of extremely preterm infants (EPIs) and evaluate the mortality and occurrence of severe complications in actively treated infants, as well as their risk factors. Methods A retrospective analysis was conducted on perinatal data of EPIs born between January 1, 2016, and December 31, 2023, who were admitted to the neonatal intensive care unit of Nanjing Women and Children's Healthcare Hospital within 24 hours after birth. The analysis focused on the attributable risk of mortality associated with different treatment attitudes in EPIs of varying gestational ages and birth weights. A multivariate logistic regression model was used to analyze the risk factors for mortality and severe complications in the actively treated group. Results A total of 485 EPIs were included. As gestational age or birth weight increased, the attributable risk of mortality with care withdrawal increased. Active treatment significantly improved the survival status of EPIs born at a gestational age of ≥24 weeks. Multivariate logistic regression analysis indicated that lower gestational age and the need for mechanical ventilation within 72 hours after birth were independent risk factors for mortality or severe complications in EPIs (P<0.05). Conclusions Active treatment can significantly extend the survival time of EPIs born at a gestational age of ≥24 weeks. Lower gestational age and the need for mechanical ventilation within 72 hours after birth are closely associated with poor survival outcomes in EPIs.

Key words

Active treatment / Mortality / Complication / Risk factor / Extremely preterm infant

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LI Meng-Meng, LI Shu-Shu, QIAN Miao, ZHANG Min, HAN Shu-Ping. Impact of different treatment attitudes on survival and risk factors for poor clinical outcomes in extremely preterm infants: a retrospective real-world study[J]. Chinese Journal of Contemporary Pediatrics. 2025, 27(3): 269-278 https://doi.org/10.7499/j.issn.1008-8830.2410006

References

1 Morgan AS, Mendon?a M, Thiele N, et al. Management and outcomes of extreme preterm birth[J]. BMJ, 2022, 376: e055924. PMID: 35012942. PMCID: PMC8744861. DOI: 10.1136/bmj-2021-055924.
2 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.
3 Cao Y, Jiang S, Sun J, et al. Assessment of neonatal intensive care unit practices, morbidity, and mortality among very preterm infants in China[J]. JAMA Netw Open, 2021, 4(8): e2118904. PMID: 34338792. PMCID: PMC8329742. DOI: 10.1001/jamanetworkopen.2021.18904.
4 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.
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 Helenius K, Sj?rs G, Shah PS, et al. Survival in very preterm infants: an international comparison of 10 national neonatal networks[J]. Pediatrics, 2017, 140(6): e20171264. PMID: 29162660. DOI: 10.1542/peds.2017-1264.
7 李秋平, 谢文瑜, 刘长根, 等. 我国新生儿科医师对超早产儿的救治态度:横断面调查[J]. 中华围产医学杂志, 2022, 25(6): 433-438. DOI: 10.3760/cma.j.cn113903-20220331-00307.
8 Jiang S, Yan W, Li S, et al. Mortality and morbidity in infants <34 weeks' gestation in 25 NICUs in China: a prospective cohort study[J]. Front Pediatr, 2020, 8: 33. PMID: 32117838. PMCID: PMC7031923. DOI: 10.3389/fped.2020.00033.
9 Arnold C, Inthorn J, Roth B, et al. Attitudes and values towards decisions at the margin of viability among expectant mothers at risk for preterm birth[J]. Acta Paediatr, 2024, 113(3): 442-448. PMID: 37942656. DOI: 10.1111/apa.17033.
10 Wilcox AJ, Cortese M, McConnaughey DR, et al. The limits of small-for-gestational-age as a high-risk category[J]. Eur J Epidemiol, 2021, 36(10): 985-991. PMID: 34661814. DOI: 10.1007/s10654-021-00810-z.
11 邵肖梅, 叶鸿瑁, 丘小汕, 等. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
12 Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging[J]. Ann Surg, 1978, 187(1): 1-7. PMID: 413500. PMCID: PMC1396409. DOI: 10.1097/00000658-197801000-00001.
13 Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary dysplasia: executive summary of a workshop[J]. J Pediatr, 2018, 197: 300-308. PMID: 29551318. PMCID: PMC5970962. DOI: 10.1016/j.jpeds.2018.01.043.
14 Chiang MF, Quinn GE, Fielder AR, et al. International classification of retinopathy of prematurity, third edition[J]. Ophthalmology, 2021, 128(10): e51-e68. PMID: 34247850. PMCID: PMC10979521. DOI: 10.1016/j.ophtha.2021.05.031.
15 Lee HC, Liu J, Profit J, et al. Survival without major morbidity among very low birth weight infants in California[J]. Pediatrics, 2020, 146(1): e20193865. PMID: 32554813. PMCID: PMC7329260. DOI: 10.1542/peds.2019-3865.
16 Zhang WW, Yu YH, Dong XY, et al. Treatment status of extremely premature infants with gestational age < 28 weeks in a Chinese perinatal center from 2010 to 2019[J]. World J Pediatr, 2022, 18(1): 67-74. PMID: 34767193. PMCID: PMC8761149. DOI: 10.1007/s12519-021-00481-6.
17 Horbar JD, Greenberg LT, Buzas JS, et al. Trends in mortality and morbidities for infants born 24 to 28 weeks in the US: 1997-2021[J]. Pediatrics, 2024, 153(1): e2023064153. PMID: 38053449. DOI: 10.1542/peds.2023-064153.
18 van Beek PE, Groenendaal F, Broeders L, et al. Survival and causes of death in extremely preterm infants in the Netherlands[J]. Arch Dis Child Fetal Neonatal Ed, 2021, 106(3): 251-257. PMID: 33158971. PMCID: PMC8070636. DOI: 10.1136/archdischild-2020-318978.
19 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.
20 吴新萍, 谷传丽, 韩树萍, 等. 极早产儿存活率和并发症的多中心回顾性研究[J]. 中国当代儿科杂志, 2021, 23(8): 814-820. PMID: 34511171. PMCID: PMC8428915. DOI: 10.7499/j.issn.1008-8830.2102037.
21 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. PMID: 38154973. DOI: 10.3760/cma.j.cn112140-20231017-00296.
22 钱苗, 沙莉, 余章斌, 等. 产房复苏质量改进对极/超低出生体重儿的影响[J]. 中华围产医学杂志, 2017, 20(5): 352-357. DOI: 10.3760/cma.j.issn.1007-9408.2017.05.010.
23 刘凤, 韩树萍, 余章斌, 等. 持续母乳喂养质量改进对极/超低出生体重儿的影响[J]. 中华围产医学杂志, 2019, 22(7): 451-456. DOI: 10.3760/cma.j.issn.1007-9408.2019.07.005.
24 曹芯诚, 蒋思远, 李淑涓, 等. 中国25家三级医院新生儿重症监护病房早产儿真菌败血症发生现状[J]. 中华儿科杂志, 2023, 61(1): 29-35. PMID: 36594118. DOI: 10.3760/cma.j.cn112140-20220918-00813.
25 Norman M, Hallberg B, Abrahamsson T, et al. Association between year of birth and 1-year survival among extremely preterm infants in Sweden during 2004-2007 and 2014-2016[J]. JAMA, 2019, 321(12): 1188-1199. PMID: 30912837. PMCID: PMC6439685. DOI: 10.1001/jama.2019.2021.