Schenone Mauro H, Aguin Eduardo, Li Yi, Lee Crystal, Kruger Michael, Bahado-Singh Ray O
Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA.
J Matern Fetal Neonatal Med. 2010 Dec;23(12):1413-8. doi: 10.3109/14767058.2010.481318. Epub 2010 May 12.
Prenatal prediction of neonatal survival and survival without short term major morbidity (STMM) in babies born at the borderline of viability.
Obstetric and neonatal records of 471 babies born from 22 0/7 to 25 6/7 weeks between the years 2000 to 2007 were reviewed. A total of 179 live-born nonanomaluos singleton infants with birth-weights of 300-1397 g, who underwent ultrasonographic examination < 7 days before delivery, qualified for the study. Ultrasound biometry, use of antenatal steroids, fetal gender, race, gestational age, estimated fetal weight, and maternal medical and obstetric characteristics were evaluated. Univariate analyses, logistic regression, and bootstrapping using 10,000 resamplings were performed to derive prediction formulas that projected neonatal outcomes. From these, quantitative patient-specific prenatal estimates of neonatal survival and survival without STMM were calculated.
On the basis of the use of prenatally available parameters, neonatal survival was predicted with a sensitivity of 85.5% and specificity of 70.6%. Area under ROC curve (95%CI) = 0.835 (0.777-0.894). Corresponding values for survival without STMM were 94.7% and 34%. Area under ROC curve (95%CI) 0.738 (0.640-0.836). Among positive predictors of survival it is worth mentioning: intact membranes, femur length ≥ 39.1 mm and estimation of fetal weight > 493 g.
Prenatal prediction of neonatal survival and STMM was achieved. This approach has the potential improve counseling and obstetric decision making at the borderline of viability.
对出生于可存活临界期的婴儿进行新生儿存活及无短期严重并发症（STMM）存活的产前预测。
回顾了2000年至2007年间出生于22 0/7至25 6/7周的471例婴儿的产科和新生儿记录。共有179例出生体重为300 - 1397克的存活非畸形单胎婴儿符合研究条件，这些婴儿在分娩前<7天接受了超声检查。评估了超声生物测量、产前类固醇的使用、胎儿性别、种族、孕周、估计胎儿体重以及母亲的医学和产科特征。进行单因素分析、逻辑回归以及使用10000次重采样的自抽样法，以得出预测新生儿结局的公式。据此，计算出针对特定患者的新生儿存活及无STMM存活的定量产前估计值。
基于产前可用参数，预测新生儿存活的敏感性为85.5%，特异性为70.6%。ROC曲线下面积（95%CI）= 0.835（0.777 - 0.894）。无STMM存活的相应值为94.7%和34%。ROC曲线下面积（95%CI）0.738（0.640 - 0.836）。在存活的阳性预测因素中，值得一提的有：胎膜完整、股骨长度≥39.1毫米以及胎儿体重估计>493克。
实现了新生儿存活及STMM的产前预测。这种方法有可能改善在可存活临界期的咨询和产科决策。
