Zayek Michael M, Trimm Riley F, Hamm Charles R, Peevy Keith J, Benjamin John T, Eyal Fabien G
Division of Neonatology, Department of Pediatrics, University of South Alabama, 1700 Center Street, Mobile, AL 36604, USA.
Arch Pediatr Adolesc Med. 2011 Feb;165(2):126-33. doi: 10.1001/archpediatrics.2010.285.
To establish the limit between beneficial and futile management in the extremely preterm infant, born at the limit of viability, at 22 to 26 weeks of gestational age (GA).
Retrospective study (11-year study period).
A tertiary regional neonatal unit.
Inborn infants (n = 841) with a birth weight of 1000 g or less and GA 2207 through 2667 weeks.
We compared mortality and neurodevelopmental outcome between 2 periods, epoch 1 (January 1998 to June 2003) and epoch 2 (July 2003 to December 2008). For neurodevelopmental data, epoch 2 extended only to December 2006.
We reviewed survival rates and adverse neurodevelopmental outcome rates at 18 to 24 months' corrected age.
In the past decade, survival rates continued to increase while neurodevelopmental impairment rates in the extremely preterm infant decreased. From epoch 1 to epoch 2, the increase in survival rate occurred in infants born at 22 weeks' estimated GA, from 20% to 40%, while the decrease in neurodevelopmental impairment (54% to 28%) and severe neurodevelopmental impairment (35% to 8%) occurred in infants born at 23 to 24 weeks' estimated GA.
Novel and aggressive neonatal therapies continue to affect neonatal outcome, mainly in infants born at the limit of viability. Our data suggest that each center offer prospective parents an assessment of the limits of viability based on their updated outcome results.
确定孕周为22至26周、处于存活极限的极早产儿有益治疗与无效治疗之间的界限。
回顾性研究（11年研究期）。
三级区域新生儿重症监护病房。
出生体重1000克及以下、孕周22⁰⁷至26⁶⁷周的活产婴儿（n = 841）。
我们比较了两个时期（时期1：1998年1月至2003年6月；时期2：2003年7月至2008年12月）的死亡率和神经发育结局。对于神经发育数据，时期2仅延长至2006年12月。
我们回顾了18至24个月矫正年龄时的生存率和不良神经发育结局发生率。
在过去十年中，极早产儿的生存率持续上升，而神经发育障碍率下降。从时期1到时期2，估计孕周为22周出生的婴儿生存率从20%上升至40%，而估计孕周为23至24周出生的婴儿神经发育障碍率（从54%降至28%）和严重神经发育障碍率（从35%降至8%）下降。
新颖且积极的新生儿治疗方法继续影响新生儿结局，主要是对处于存活极限的婴儿。我们的数据表明，每个中心应根据最新的结局结果为未来的父母提供关于存活极限的评估。
