Ogawa Masaki, Matsuda Yoshio, Kanda Eriko, Konno Jun, Mitani Minoru, Makino Yasuo, Matsui Hideo
Perinatal Medical Center, Tokyo Women's Medical University Hospital, Kawadacho 8-1, Shinjuku, Tokyo 1628666, Japan ; Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo 1628666, Japan.
Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo 1628666, Japan.
ISRN Obstet Gynecol. 2013 Nov 25;2013:873563. doi: 10.1155/2013/873563. eCollection 2013.
Aim. To clarify the effect of perinatal events on the survival of ELBW infants in Japan. Methods. 1,713 ELBW infants, from 92,630 live births in 2001 and 2002, born at 22-36 weeks of gestation were registered. Case was defined as death at discharge. The relevant variables were compared between the cases (n = 366) and the controls (n = 1,347). Results. The total survival rate was 78.6%. There was a significant difference between the survival rate in cesarean and vaginal delivery at 24-31 weeks of gestation. Cesarean delivery in infants with a birth weight >400 g was significantly advantageous to the survival rate of ELBW infants than vaginal delivery. The significant contributing factors were gestational age at delivery (OR: 0.97), Apgar score at 5 min (0.56), antenatal steroid (0.41), and birth weight (0.996). Nonvertex presentation (1.81), vaginal delivery (1.56), and placental abruption (2.50) were found to be significantly associated with neonatal death. Conclusions. Cesarean section might be advantageous for survival in ELBW infants over 24 gestational weeks or 400 grams of birth weight. Nonvertex presentation, vaginal delivery, and placental abruption could be significant risk factors for survival of ELBW infants.
目的。阐明围产期事件对日本超低出生体重儿生存的影响。方法。登记了2001年和2002年92,630例活产中出生于妊娠22 - 36周的1713例超低出生体重儿。病例定义为出院时死亡。对病例组（n = 366）和对照组（n = 1347）的相关变量进行比较。结果。总生存率为78.6%。在妊娠24 - 31周时，剖宫产和阴道分娩的生存率存在显著差异。出生体重>400 g的婴儿剖宫产对超低出生体重儿的生存率明显优于阴道分娩。显著的影响因素为分娩时的孕周（比值比：0.97）、5分钟阿氏评分（0.56）、产前使用类固醇（0.41）和出生体重（0.996）。发现胎位异常（1.81）、阴道分娩（1.56）和胎盘早剥（2.50）与新生儿死亡显著相关。结论。剖宫产可能对妊娠24周以上或出生体重400克以上的超低出生体重儿的生存有利。胎位异常、阴道分娩和胎盘早剥可能是超低出生体重儿生存的重要危险因素。
