Department of Neonatology, KK Women's and Children's Hospital, Singapore.
Ann Acad Med Singap. 2013 Jul;42(7):328-37.
This study assesses the trends and predictors of mortality and morbidity in infants of gestational age (GA) <27 weeks from 1990 to 2007.
This is a retrospective cross-sectional cohort study of infant deliveries between 1990 and 2007 in the largest perinatal centre in Singapore. This is a study of infants born at <27 weeks in 2 Epochs (Epoch 1 (E1):1990 to 1998, Epoch 2 (E2):1999 to 2007) using logistic regression models to identify factors associated with mortality and composite morbidity. The main outcomes that were measured were the trends and predictors of mortality and morbidity.
Four hundred and eight out of 615 (66.3%) live born infants at 22 to 26 weeks survived to discharge. Survival improved with increasing GA from 22% (13/59) at 23 weeks to 87% (192/221) at 26 weeks (P <0.01). Survival rates were not different between E1 and E2, (61.5% vs 68.8%). In logistic regression analysis, higher survival was independently associated with increasing GA and birthweight, while airleaks, severe intraventricular haemorrhage (IVH) and necrotizing enterocolitis (NEC) contributed to increased mortality. Rates of major neonatal morbidities were bronchopulmonary dysplasia (BPD) (45%), sepsis (35%), severe retinopathy of prematurity (ROP) (31%), severe IVH/ periventricular leucomalacie (PVL) (19%) and NEC (10%). Although composite morbidity comprising any of the above was not significantly different between the 2 Epochs (75% vs 73%) a decreasing trend was seen with increasing GA (P <0.001). Composite morbidity/ mortality was significantly lower at 26 weeks (58%) compared to earlier gestations (P <0.001, OR 0.37, 95% CI, 0.28 to 0.48) and independently associated with decreasing GA and birth weight, male sex, hypotension, presence of patent ductus arteriosus (PDA) and airleaks.
Increasing survival and decreasing composite morbidity was seen with each increasing week in gestation with marked improvement seen at 26 weeks. Current data enables perinatal care decisions and parental counselling.
本研究评估了 1990 年至 2007 年胎龄（GA）<27 周的婴儿的死亡率和发病率趋势及预测因素。
这是一项对新加坡最大围产期中心 1990 年至 2007 年期间分娩的婴儿进行的回顾性、横断面队列研究。该研究纳入了 2 个时期（时期 1（E1）：1990 年至 1998 年；时期 2（E2）：1999 年至 2007 年）出生的<27 周的婴儿，采用逻辑回归模型来确定与死亡率和复合发病率相关的因素。主要结局指标为死亡率和发病率的趋势和预测因素。
22 至 26 周出生的 615 例活产婴儿中，408 例（66.3%）存活至出院。存活率随胎龄增加而提高，从 23 周时的 22%（13/59）提高到 26 周时的 87%（192/221）（P<0.01）。E1 和 E2 期间的存活率无差异（61.5% vs 68.8%）。逻辑回归分析表明，存活率的独立预测因素为胎龄和出生体重增加，而肺气漏、严重脑室内出血（IVH）和坏死性小肠结肠炎（NEC）则增加了死亡率。主要新生儿并发症发生率为支气管肺发育不良（BPD）（45%）、败血症（35%）、严重早产儿视网膜病变（ROP）（31%）、严重 IVH/脑室周围白质软化（PVL）（19%）和 NEC（10%）。尽管两个时期的复合发病率（任何一种并发症的发生率）无显著差异（75% vs 73%），但随着胎龄增加，复合发病率呈下降趋势（P<0.001）。与较早的胎龄相比，26 周时复合发病率/死亡率明显更低（P<0.001，OR 0.37，95%CI，0.28 至 0.48），且与胎龄和出生体重降低、男性、低血压、动脉导管未闭（PDA）和肺气漏的存在独立相关。
胎龄每增加一周，存活率提高，复合发病率下降，26 周时改善显著。目前的数据有助于围产期护理决策和家长咨询。
