Champion V, Durrmeyer X, Dassieu G
Service de réanimation néonatale, hôpital intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
Arch Pediatr. 2010 Jan;17(1):19-25. doi: 10.1016/j.arcped.2009.10.002. Epub 2009 Nov 11.
The rate of infants born at 34-36 weeks gestation has increased over the last 10 years. These babies are at higher risk of morbidity and mortality than full-term infants. At present, prenatal steroids are given until 34 weeks. The purpose of this study was to present the epidemiologic data of the late preterm infants and look for respiratory distress risk factors. This is a descriptive, single-center study including 59, 55 and 72 children born at 34, 35 and 36 weeks gestation, respectively, in a level III center in 2005 and 2006 for babies born at 34 weeks and in 2006 for the babies born at 35 and 36 weeks. Of the mothers who delivered at 34 and 35 weeks, 63% and 49%, respectively, had a morbidity. The cesarean-section delivery rate before labor was 36% for the infants born at 34 weeks and 25% for the infants born at 35 weeks. Prenatal steroids were used for 57% of the mothers who delivered at 34 weeks and for 27% of the mothers who delivered at 35 weeks. In the population of the babies born at 34 weeks, a mean delay between the last dose of steroid and delivery was 18.9 days. Of the infants born at 34, 35 and 36 weeks, 27%, 18% and 8% suffered from respiratory distress. The mechanical ventilation rate was 8.5% and 5.5% for the infants born at 34 and 35 weeks' gestation. Surfactant was given to all infants born at 34 weeks who were intubated. Twenty percent of the 34-week-gestation infants and 12.7% of the 35-week-gestation infants required mechanical ventilation or noninvasive continuous positive airway pressure. Respiratory distress was mainly caused by respiratory distress syndrome or transient tachypnea of the newborn. There were no cases of meconium aspiration syndrome. There was 1 case of infection and 2 cases of pneumothorax. One-third of the infants born at 34-35 weeks were admitted to the neonatal intensive care unit. The number dropped to 11% at 36 weeks' gestation. The gestational age was the only significant risk factor for respiratory distress. There was a strong tendency of the respiratory distress rate to decrease in the babies whose mothers had received steroids (odds ratio = 0.39, p = 0.06).
在过去10年中,孕34 - 36周出生的婴儿比例有所上升。这些婴儿比足月儿面临更高的发病和死亡风险。目前,产前使用类固醇药物至34周。本研究的目的是呈现晚期早产儿的流行病学数据,并寻找呼吸窘迫的风险因素。这是一项描述性单中心研究,分别纳入了2005年和2006年在一家三级医疗中心出生的59名、55名和72名孕34周、35周和36周的婴儿,其中孕34周的婴儿数据来自2005年,孕35周和36周的婴儿数据来自2006年。在孕34周和35周分娩的母亲中,分别有63%和49%患有疾病。孕34周出生婴儿的产前剖宫产率为36%,孕35周出生婴儿的产前剖宫产率为25%。孕34周分娩的母亲中有57%使用了产前类固醇药物,孕35周分娩的母亲中有27%使用了该药物。在孕34周出生的婴儿群体中,最后一剂类固醇药物与分娩之间的平均间隔为18.9天。孕34周、35周和36周出生的婴儿中,分别有27%、18%和8%出现呼吸窘迫。孕34周和35周出生婴儿的机械通气率分别为8.5%和5.5%。所有孕34周出生且插管的婴儿均接受了表面活性剂治疗。孕34周出生的婴儿中有20%、孕35周出生的婴儿中有12.7%需要机械通气或无创持续气道正压通气。呼吸窘迫主要由呼吸窘迫综合征或新生儿短暂性呼吸急促引起。未出现胎粪吸入综合征病例。有1例感染和2例气胸病例。孕34 - 35周出生的婴儿中有三分之一被收入新生儿重症监护病房。孕36周时这一比例降至11%。胎龄是呼吸窘迫的唯一显著风险因素。母亲接受过类固醇药物治疗的婴儿,其呼吸窘迫率有显著下降趋势(优势比 = 0.39,p = 0.06)。