MBBS, Royal Women's Hospital, Department of Newborn Services, 20 Flemington Rd, Parkville, Victoria 3052, Australia.
Pediatrics. 2010 Mar;125(3):e559-64. doi: 10.1542/peds.2009-1307. Epub 2010 Feb 22.
Some neonatologists state that at the delivery of extremely premature infants they rely on "how the baby looks" when deciding whether to initiate resuscitation. Previous studies have reported poor correlation between early clinical signs and prognosis.
To determine if neonatologists can accurately predict survival to discharge of extremely premature infants on the basis of observations in the first minutes after birth.
We showed videos of the resuscitation of 10 extremely premature infants (<26 weeks' gestation) to attending neonatologists and fellows from the 3 major perinatal centers in Melbourne, Australia. Antenatal information was available to the observers. A monitor visible in each video displayed the heart rate and oxygen saturation of the infant. Observers were asked to estimate the likelihood of survival to discharge for each infant at 3 time points: 20 seconds, 2 minutes, and 5 minutes after birth. The predictive ability of observers was expressed as the area (95% confidence interval [CI]) under the receiver-operating-characteristic curve.
Seventeen attending neonatologists and 17 neonatal fellows completed the study. Receiver-operating-characteristic curves were generated for the combined and individual groups. Observers' ability to predict survival was poor (combined results): 0.61 (95% CI: 0.54-0.67) at 20 seconds, 0.59 (95% CI: 0.52-0.64) at 2 minutes, and 0.61 (95% CI: 0.55-0.67) at 5 minutes. Level of experience did not affect the observers' accuracy of predicting survival.
Neonatologists' reliance on initial appearance and early response to resuscitation in predicting survival for extremely premature infants is misplaced.
一些新生儿科医生表示，在为极早产儿接生时，他们会根据“婴儿的外观”来决定是否开始复苏。先前的研究报告表明，早期临床体征与预后之间相关性较差。
确定新生儿科医生是否能够根据出生后最初几分钟的观察结果准确预测极早产儿的存活至出院。
我们向澳大利亚墨尔本的 3 家主要围产中心的主治新生儿科医生和研究员展示了 10 名极早产儿（<26 周胎龄）复苏的视频。观察者可获得产前信息。每个视频中的监视器都显示了婴儿的心率和血氧饱和度。观察者被要求在出生后 20 秒、2 分钟和 5 分钟时，分别对每个婴儿的存活可能性进行估计。观察者的预测能力用受试者工作特征曲线下的面积（95%置信区间[CI]）表示。
17 名主治新生儿科医生和 17 名新生儿研究员完成了这项研究。生成了综合和个体组的受试者工作特征曲线。观察者预测存活的能力较差（综合结果）：出生后 20 秒时为 0.61（95%CI：0.54-0.67），2 分钟时为 0.59（95%CI：0.52-0.64），5 分钟时为 0.61（95%CI：0.55-0.67）。经验水平并未影响观察者预测存活的准确性。
新生儿科医生依赖于初始外观和对复苏的早期反应来预测极早产儿的存活是错误的。
