北部地区某医学中心之晚期早产儿盛行率与罹病率：现况分析。
Prevalence and morbidity of late preterm infants: current status in a medical center of Northern Taiwan.
机构信息
Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
出版信息
Pediatr Neonatol. 2012 Jun;53(3):171-7. doi: 10.1016/j.pedneo.2012.04.003. Epub 2012 Jun 5.
BACKGROUND
"Late preterm" defines infants born at 34(0/7) through 36(6/7) weeks' gestation, which comprise a majority of preterm births. These infants were treated clinically as "near-term" in the past, but recent studies have implied increased morbidities that differentiate late preterm and term infants. The purpose of this study was to examine the prevalence and clinical complications that could be associated with late preterm birth, as compared to term.
METHODS
This was a retrospective cohort study that reviewed infants born in a medical center in Northern Taiwan during a 2-year period between 2008 and 2009. Maternal obstetrical factors, neonatal demographic distributions, and neonatal complications were compared between full-term and late preterm deliveries.
RESULTS
During the study period, there were 7998 live births in the institute, including 6507 term and 1491 preterm infants. Of the latter, there were 914 (61.3%) born after 34 weeks' gestation. The Neonatal Intensive Care Unit (NICU) (including a special care nursery) admission rate was higher in late preterm infants when compared to term (36% vs. 2%), and was 74%, 43%, and 21% in infants born at 34, 35, and 36 weeks' gestation, respectively. Compared with term infants, late-preterm infants had longer hospital stay if admitted to NICU (including special care nursery) (17 days vs. 10 days), and they were associated with increased risk of neonatal morbidities, including respiratory distress syndrome (2.6% vs. 0.02%), respiratory distress of other etiologies (16% vs. 2%), culture-proven sepsis (0.7% vs. 0.2%), hypoglycemia (3% vs. 0.4%), temperature instability (0.4% vs. 0.05%), feeding difficulty (2% vs. 0.4%), and hyperbilirubinemia needing phototherapy (14% vs. 3%). Late-preterm infants also had higher hospital readmission rate (4.4% vs. 2.3%, p<0.001) and neonatal mortality rate (0.3% vs. 0.08%, p=0.03).
CONCLUSION
Late-preterm infants have increased risk of neonatal morbidities associated with organ immaturity. The results of this study emphasize the importance of judicious obstetrical decision-making when considering late preterm delivery, and the need to set up anticipatory clinical guidelines for the care of late preterm infants.
背景
“晚期早产儿”是指胎龄为 34（0/7）周到 36（6/7）周的婴儿，他们占早产儿的大多数。这些婴儿过去在临床上被视为“近足月”，但最近的研究表明，晚期早产儿和足月婴儿之间存在差异，晚期早产儿的发病率更高。本研究的目的是探讨与足月相比，晚期早产儿出生时的患病率和临床并发症。
方法
这是一项回顾性队列研究，对 2008 年至 2009 年期间在台湾北部一家医疗中心出生的婴儿进行了研究。比较了足月和晚期早产儿的产妇产科因素、新生儿人口统计学分布和新生儿并发症。
结果
在研究期间，该研究所共有 7998 例活产儿，其中 6507 例为足月产儿，1491 例为早产儿。后者中，有 914 例（61.3%）出生于 34 周以后。与足月产儿相比，晚期早产儿在新生儿重症监护病房（NICU）（包括特别护理病房）的入院率更高（36% vs. 2%），分别出生于 34 周、35 周和 36 周的早产儿的 NICU（包括特别护理病房）入院率分别为 74%、43%和 21%。与足月产儿相比，晚期早产儿如果入住 NICU（包括特别护理病房），其住院时间更长（17 天 vs. 10 天），并且与新生儿发病率的增加有关，包括呼吸窘迫综合征（2.6% vs. 0.02%）、其他病因的呼吸窘迫（16% vs. 2%）、培养阳性败血症（0.7% vs. 0.2%）、低血糖（3% vs. 0.4%）、体温不稳定（0.4% vs. 0.05%）、喂养困难（2% vs. 0.4%）和需要光疗的高胆红素血症（14% vs. 3%）。晚期早产儿的住院再入院率（4.4% vs. 2.3%，p<0.001）和新生儿死亡率（0.3% vs. 0.08%，p=0.03）也更高。
结论
晚期早产儿的发病率更高，与器官不成熟有关。本研究结果强调了在考虑晚期早产儿分娩时应谨慎做出产科决策的重要性，并需要为晚期早产儿的护理制定预期的临床指南。
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