Bagnoli F, Conte M L, Tomasini B, Bellieni C V, Borlini G, De Felice C, Perrone S, Zani S, Gatti M G
Unità Operativa Complessa, Terapia Intensiva Neonatale, Dipartimento di Pediatria, Ostetricia e Medicina della Riproduzione, Azienda Ospedaliera Universitaria Senese, Siena, Italia.
Minerva Pediatr. 2010 Feb;62(1):29-41.
The aim of this study was to evaluate survival rates in a single Neonatal Intensive Care Unit (NICU) (period 2002-2007), with a special focus on the survival data and outcome at one-year of corrected age for infants born at 23-25 weeks of gestation.
All infants who had evidence of heart activity at birth were actively resuscitated, regardless of birth weight or gestational age. Survival rate was calculated as a function of the following variables: birth weight and gestational category; gender in infants of birth weight < or = 1000 g ; appropriate (AGA) or small (SGA) weight for gestational age; inborn or outborn. Twenty-eight newborns (23-25 weeks of gestation) completed follow-up at one-year of corrected age.
During the examined period, no infants died in the delivery room; 833 newborns were admitted to the NICU. Overall survival rates were as following: <500 g (37%), 501-750 g (59%), 751-1,000 g (82%), 1,001-1,250 g (96%), 1251-1,500 g (97%), 1,501-2,000 g (100%), 2,001-2,500 g (98%), >2,500 g (99%); 23-25 weeks of gestation (50%); 26-27 weeks (77%), 28-32 weeks (90%); males < or = 1,000 g (68%), females < or = 1,000 g (68%); AGA < or = 1,000 g (63%), SGA < or = 1,000 g (79%), AGA < or =28 weeks (63%), SGA < or = 28 weeks (67%); inborn (54%), outborn (25%). A fraction of 64% (infants of 23-25 weeks of gestation) did not show handicap at one-year of corrected age, while 25% presented severe, 7% moderate, and 4% mild handicaps.
High rate of survival without handicap at one-year of corrected age at extremely low gestational age and the chance of improvements in neonatal care for newborn < or = 24 weeks, indicate the appropriateness for our strategy of resuscitating all newborns with evidence of heart activity in the delivery room.
本研究旨在评估单一新生儿重症监护病房（NICU）（2002 - 2007年期间）的存活率，特别关注妊娠23 - 25周出生婴儿在矫正年龄一岁时的存活数据和结局。
所有出生时有心脏活动迹象的婴儿均积极进行复苏，无论出生体重或胎龄如何。存活率根据以下变量计算：出生体重和妊娠类别；出生体重≤1000g婴儿的性别；适合胎龄（AGA）或小于胎龄（SGA）；院内出生或院外出生。28例（妊娠23 - 25周）新生儿在矫正年龄一岁时完成随访。
在研究期间，产房内无婴儿死亡；833例新生儿入住NICU。总体存活率如下：<500g（37%），501 - 750g（59%），751 - 1000g（82%），1001 - 1250g（96%），1251 - 1500g（97%），1501 - 2000g（100%），2001 - 2500g（98%），>2500g（99%）；妊娠23 - 25周（50%）；26 - 27周（77%），28 - 32周（90%）；出生体重≤1000g男性（68%），出生体重≤1000g女性（68%）；AGA≤1000g（63%），SGA≤1000g（79%），AGA≤28周（63%），SGA≤28周（67%）；院内出生（54%），院外出生（25%）。64%（妊娠23 - 25周的婴儿）在矫正年龄一岁时无残疾，而25%有严重残疾，7%有中度残疾，4%有轻度残疾。
极低胎龄婴儿在矫正年龄一岁时无残疾的高存活率以及对≤24周新生儿新生儿护理改善的可能性，表明我们在产房对所有有心脏活动迹象的新生儿进行复苏的策略是合适的。
