高危极低出生体重儿的结局：胎龄≤24周、出生体重≤750克且1分钟阿氏评分≤3分。

Outcome of extremely-low-birth-weight infants at highest risk: gestational age < or =24 weeks, birth weight < or =750 g, and 1-minute Apgar < or =3.

作者信息

Shankaran Seetha, Johnson Yvette, Langer John C, Vohr Betty R, Fanaroff Avroy A, Wright Linda L, Poole W Kenneth

机构信息

Wayne State University, Detroit, MI, USA.

出版信息

Am J Obstet Gynecol. 2004 Oct;191(4):1084-91. doi: 10.1016/j.ajog.2004.05.032.

DOI:10.1016/j.ajog.2004.05.032

PMID:15507925

Abstract

OBJECTIVE

The purpose of this study was to evaluate neurodevelopmental outcome in extremely-low-birth-weight (ELBW) infants, all of whom had 3 characteristics: gestational age (GA) < or =24 weeks, birth weight < or =750 g, and 1-minute Apgar score < or =3.

STUDY DESIGN

Surviving infants were evaluated at 18 to 22 months' corrected age with a neurologic examination and the Bayley II Mental and Psychomotor Developmental Index (MDI and PDI).

RESULTS

Between 1993 and 1999, 1016 infants had GA < or =24 weeks, birth weight < or =750 g, and 1-minute Apgar score < or =3. Of 246 survivors, 30% had cerebral palsy (CP), 5% had hearing impairment, and 2% were blind. MDI was > or =85 in 33% and < 70 in 46% of infants, while PDI was > or =85 in 41% and < 70 in 36% infants. Predictors of MDI < 70 were grade III-IV ICH, cystic periventricular leukomalacia (PVL), male gender, black race, and Medicaid insurance. Two-parent household was associated with an MDI >70. Predictors of PDI < 70 were grade III-IV ICH, PVL, steroids for bronchopulmonary dysplasia (BPD), and Medicaid insurance. CP was associated with grade III-IV ICH and PVL.

CONCLUSION

Perinatologists and neonatologists should be aware of the risk of morbidity and mortality in this high-risk ELBW group.

摘要

目的

本研究旨在评估极早早产儿（ELBW）的神经发育结局，所有这些婴儿都有以下3个特征：胎龄（GA）≤24周、出生体重≤750克、1分钟阿氏评分≤3分。

研究设计

对存活婴儿在矫正年龄18至22个月时进行神经系统检查以及贝利婴幼儿发展量表第二版的智力和心理运动发展指数（MDI和PDI）评估。

结果

1993年至1999年间，1016例婴儿胎龄≤24周、出生体重≤750克、1分钟阿氏评分≤3分。在246名存活者中，30%患有脑瘫（CP），5%有听力障碍，2%失明。33%的婴儿MDI≥85，46%＜70；41%的婴儿PDI≥85，36%＜70。MDI＜70的预测因素为III-IV级颅内出血（ICH）、脑室周围白质软化（PVL）、男性、黑人种族以及医疗补助保险。双亲家庭与MDI＞70相关。PDI＜70的预测因素为III-IV级ICH、PVL、用于支气管肺发育不良（BPD）的类固醇药物以及医疗补助保险。CP与III-IV级ICH和PVL相关。