Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Obstet Gynecol. 2012 Apr;119(4):795-800. doi: 10.1097/AOG.0b013e31824b1a03.
OBJECTIVE: To estimate observed compared with predicted survival rates of extremely premature infants born during 2000-2009, to identify contemporary predictors of survival, and to determine if improved survival rates occurred during the decade. METHODS: We conducted a retrospective cohort analysis of 237 inborn neonates without major congenital anomalies born from 2000 to 2009 after 22 to 25 completed weeks of gestation. Observed survival rates at each gestational age were compared with predicted survival rates based on gestational age, birth weight, sex, singleton or multiple gestation, and antenatal corticosteroid administration estimated by a Web-based calculator that was derived from 1998 to 2003 outcomes of a large national cohort. Multivariable logistic regression analysis was used to identify significant predictors of survival of the study cohort, including year of birth. RESULTS: Survival rates for the decade by gestational age (compared with predicted rates) were: 22 weeks, 33% (compared with 19%); 23 weeks, 58% (compared with 38%); 24 weeks, 87% (compared with 58%); and 25 weeks, 85% (compared with 70%). Antenatal corticosteroids were administered in 96% of pregnancies. Variables that significantly predicted survival and their odds ratios (OR) with 95% confidence intervals (CI) are: antenatal corticosteroid administration (OR 5.27, CI 1.26-22.08); female sex (OR 3.21, CI 1.42-7.26); gestational age (OR 1.89, CI 1.27-2.81); 1-minute Apgar score (OR 1.39, CI 1.15-1.69); and birth year (OR 1.17, CI 1.02-1.34). The number needed to treat with any antenatal corticosteroid therapy to prevent one death was 2.4. CONCLUSION: In this single-institution cohort treated aggressively (antenatal corticosteroid administration [even if less than 24 weeks], tocolysis until steroid course complete, cesarean for fetal distress) by perinatologists and neonatologists, survival rates at 22-25 weeks of gestation age for inborn infants during the 2000s exceeded predicted rates, with increasing odds of survival during the decade. Antenatal corticosteroid administration had a significant effect on survival. LEVEL OF EVIDENCE: II.
目的：评估 2000-2009 年期间出生的极早产儿的实际存活率与预测存活率，识别当代存活率的预测因素，并确定该十年间是否存在存活率提高的情况。
方法：我们对 2000 至 2009 年间在 22-25 孕周后出生且无重大先天畸形的 237 例宫内新生儿进行了回顾性队列分析。通过基于胎龄、出生体重、性别、单胎或多胎、产前皮质类固醇使用（基于源自 1998 至 2003 年大型全国队列的网络计算器进行估计）的胎龄计算预测存活率，并将每个胎龄的实际存活率与预测存活率进行比较。多变量逻辑回归分析用于确定研究队列存活率的显著预测因素，包括出生年份。
结果：该十年内各胎龄的存活率（与预测值相比）为：22 孕周为 33%（预测值为 19%）；23 孕周为 58%（预测值为 38%）；24 孕周为 87%（预测值为 58%）；25 孕周为 85%（预测值为 70%）。96%的妊娠使用了产前皮质类固醇。显著预测存活率的变量及其 95%置信区间（CI）的比值比（OR）为：产前皮质类固醇使用（OR 5.27，CI 1.26-22.08）；女性（OR 3.21，CI 1.42-7.26）；胎龄（OR 1.89，CI 1.27-2.81）；1 分钟 Apgar 评分（OR 1.39，CI 1.15-1.69）；以及出生年份（OR 1.17，CI 1.02-1.34）。需要使用任何产前皮质类固醇治疗来预防 1 例死亡的人数为 2.4。
结论：在本单中心队列中，由围产医生和新生儿科医生积极治疗（即使胎龄<24 周，产前皮质类固醇治疗[甚至如果胎龄<24 周]，在皮质类固醇疗程结束前使用宫缩抑制剂，胎儿窘迫时行剖宫产），2000 年代 22-25 孕周出生的宫内新生儿的存活率超过了预测值，并且在十年间存活率的可能性呈上升趋势。产前皮质类固醇的使用对存活率有显著影响。
证据等级：II 级。
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