Maternal & Child Health Comparative Effectiveness Research Group, Department of Epidemiology & Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, FL.
Semin Perinatol. 2013 Dec;37(6):389-400. doi: 10.1053/j.semperi.2013.06.021.
The objective of this paper is to review observational studies that addressed the survival of pre-viable gestations in the United States. We searched PubMed, Ovid, CINAHL, and Web of Knowledge for studies reporting survival of infants born at <24 gestational weeks and/or <500g in the United States and published between January 2003 and January 2013. The full texts of 70 articles were examined and a total of 15 studies qualified and were selected. We analyzed fixed-effect and random-effects models for eight studies on survival to discharge. Pooled survival to discharge in the random-effects model was 45.9% (95% CI: 41.1-51.7) and 39.7% in the fixed-effect model (95% CI: 38.8-40.7). Studies differed by pre-viable survival measures and epochs (1985-2009). Protective factors included antenatal corticosteroids, neonatal resuscitation, and intensive care. The current survival threshold for pre-viable infants warrants reconsideration of the limits of viability. Protective factors that enhance survival should be considered in the management of these infants.
本文旨在回顾美国关于极早早产儿存活率的观察性研究。我们检索了 PubMed、Ovid、CINAHL 和 Web of Knowledge，以寻找 2003 年 1 月至 2013 年 1 月期间在美国发表的、报告胎龄<24 周和/或出生体重<500g 的婴儿存活率的研究。我们对 70 篇文章的全文进行了评估，共有 15 项研究符合条件并被选中。我们分析了 8 项关于出院存活率的固定效应和随机效应模型研究。随机效应模型的出院存活率为 45.9%（95%CI：41.1-51.7），固定效应模型为 39.7%（95%CI：38.8-40.7）。这些研究因极早早产儿存活率的测量和时期（1985-2009 年）而异。保护因素包括产前皮质激素、新生儿复苏和重症监护。目前极早早产儿的生存阈值需要重新考虑其生存极限。应该在这些婴儿的治疗中考虑增强存活率的保护因素。
