Håkansson Stellan, Farooqi Aijaz, Holmgren Per Ake, Serenius Fredrik, Högberg Ulf
Department of Pediatrics, Institution of Clinical Science, University Hospital, Umeå, Sweden.
Pediatrics. 2004 Jul;114(1):58-64. doi: 10.1542/peds.114.1.58.
There is a need for evidence-based knowledge regarding perinatal management in extreme prematurity. The benefit of a proactive attitude versus a more selective one is controversial. The objective of the present study was to analyze perinatal practices and infant outcome in extreme prematurity in relation to different management policies in the North (proactive) and South of Sweden.
A population-based, retrospective, cohort study design was used. Data in the Swedish Medical Birth Register (MBR) from 1985 to 1999 were analyzed according to region of birth and gestational age (22 weeks + 0 days to 27 weeks + 6 days). A total of 3 602 live-born infants were included (North = 1040, South = 2562). Survival was defined as being alive at 1 year. Morbidity in survivors, based on discharge diagnoses of major morbidity during the first year of life, was described by linking the MBR to the Hospital Discharge Register.
In infants with a gestational age of 22 to 25 weeks, the proactive policy was significantly associated with 1) increased incidence of live births, 2) higher degree of centralized management, 3) higher frequency of caesarean section, 4) fewer infants with low Apgar score (<4) at 1 and 5 minutes, 5) fewer infants dead within 24 hours, and 6) increased number of infants alive at 1 year. There were no indications of increased morbidity in survivors of the proactive management during the first year of life, and the proportion of survivors without denoted morbidity was larger.
In infants with a gestational age of 22 to 25 weeks, a proactive perinatal strategy increases the number of live births and improves the infant's postnatal condition and survival without evidence of increasing morbidity in survivors up to 1 year of age.
对于极早产儿围产期管理，需要基于证据的知识。积极主动的态度与更具选择性的态度相比，其益处存在争议。本研究的目的是分析瑞典北部（积极主动型）和南部不同管理政策下极早产儿的围产期实践及婴儿结局。
采用基于人群的回顾性队列研究设计。根据出生地区和孕周（22周0天至27周6天），对瑞典医学出生登记处（MBR）1985年至1999年的数据进行分析。共纳入3602例活产婴儿（北部=1040例，南部=2562例）。生存定义为1岁时存活。通过将MBR与医院出院登记处相链接，根据生命第一年主要疾病的出院诊断描述存活者的发病率。
在孕周为22至25周的婴儿中，积极主动型政策与以下方面显著相关：1）活产发生率增加；2）集中管理程度更高；3）剖宫产频率更高；4）1分钟和5分钟时Apgar评分低（<4分）的婴儿更少；5）24小时内死亡的婴儿更少；6）1岁时存活的婴儿数量增加。在生命的第一年，积极主动型管理的存活者没有发病率增加的迹象，且无明确疾病的存活者比例更大。
对于孕周为22至25周的婴儿，积极主动的围产期策略可增加活产数量，改善婴儿出生后的状况和存活率，且在1岁前的存活者中没有发病率增加的证据。
