Vanhaesebrouck Piet, Allegaert Karel, Bottu Jean, Debauche Christian, Devlieger Hugo, Docx Martine, François Anne, Haumont Dominique, Lombet Jacques, Rigo Jacques, Smets Koenraad, Vanherreweghe Inge, Van Overmeire Bart, Van Reempts Patrick
Department of Neonatology, University Hospital Ghent, De Pintelaan 185 B-9000 Ghent, Belgium.
Pediatrics. 2004 Sep;114(3):663-75. doi: 10.1542/peds.2003-0903-L.
To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at <or=26 weeks' gestation.
Perinatal data were collected on extremely preterm infants who were alive at the onset of labor and born between January 1, 1999, and December 31, 2000, in all 19 Belgian perinatal centers.
A total of 525 infants were recorded. Life-supporting care was provided to 322 liveborn infants, 303 of whom were admitted for intensive care. The overall survival rate of liveborn infants was 54%. Of the infants who were alive at the age of 7 days, 82% survived to discharge. Vaginal delivery, shorter gestation, air leak, longer ventilator dependence, and higher initial oxygen need all were independently associated with death; gender, plurality, and surfactant therapy were not. Among the 175 survivors, 63% had 1 or more of the 3 major adverse outcome variables at the time of discharge (serious neuromorbidity, chronic lung disease at 36 weeks' postmenstrual age, or treated retinopathy of prematurity). The chance of survival free from serious neonatal morbidity at the time of hospital discharge was <15% (21 of 158) for the admitted infants with a gestation <26 weeks.
If for the time being prolongation of pregnancy is unsuccessful, then outcome perspectives should be discussed and treatment options including nonintervention explicitly be made available to parents of infants of <26 weeks' gestation within the limits of medical feasibility and appropriateness.
确定以人群为基础的大量孕周小于或等于26周出生的婴儿出院时的死亡率和发病率。
收集了1999年1月1日至2000年12月31日期间比利时所有19个围产期中心分娩开始时存活的极早产儿的围产期数据。
共记录了525名婴儿。对322名活产婴儿提供了生命支持护理，其中303名婴儿被收入重症监护病房。活产婴儿的总体存活率为54%。7天时存活的婴儿中，82%存活至出院。阴道分娩、孕周较短、气漏、呼吸机依赖时间较长和初始吸氧需求较高均与死亡独立相关；性别、多胎妊娠和表面活性剂治疗则无关。在175名幸存者中，63%在出院时存在3个主要不良结局变量中的1个或更多（严重神经疾病、孕龄36周时的慢性肺病或治疗性早产儿视网膜病变）。对于孕周小于26周的入院婴儿，出院时无严重新生儿疾病存活的几率小于15%（158名中的21名）。
如果目前延长孕周未成功，那么应在医学可行性和适当性的范围内，与孕周小于26周婴儿的父母讨论结局前景，并明确提供包括不干预在内的治疗选择。
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