Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany.
Institute of Medical Statistics, Informatics, and Epidemiology, University of Cologne, Cologne, Germany.
JAMA Pediatr. 2016 Jul 1;170(7):671-7. doi: 10.1001/jamapediatrics.2016.0207.
Rates of survival for infants born at the border of viability are still low and vary considerably among neonatal intensive care units.
To determine whether higher survival rates and better short-term outcomes for infants born at 22 or 23 weeks' gestation may be achieved by active prenatal and postnatal care.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of 106 infants born at 22 or 23 weeks of gestation at a level III neonatal intensive care unit at the University of Cologne Medical Centre in Cologne, Germany, between January 1, 2010, and December 31, 2014. Data analysis was performed in June 2015.
Active prenatal and postnatal care.
Survival until hospital discharge and survival without neonatal or short-term severe complications (defined as high-grade intraventricular hemorrhage, surgery for abdominal complications, bronchopulmonary dysplasia, or retinopathy of prematurity).
Of 106 liveborn infants (45 born at 22 weeks and 61 born at 23 weeks and 6 days), 20 (19%) received palliative care (17 born at 22 weeks and 3 born at 23 weeks), and 86 (81%) received active care (28 born at 22 weeks and 58 born at 23 weeks). Of the 86 infants who received active care (mean [SD] maternal age, 32 [6] years), 58 (67%) survived until hospital discharge (17 born at 22 weeks and 41 born at 23 weeks). Eighty-five infants survived without severe complications, with 1 infant born at 22 weeks excluded because of missing data (6 of 27 [22%] born at 22 weeks, and 16 of 58 [28%] born at 23 weeks). Survival was predicted by the Apgar score after 5 minutes (odds ratio, 0.62 [95% CI, 0.46-0.84]) and birth weight (odds ratio, 0.001 [95% CI, 0.00-0.40]).
One in 4 infants born at the border of viability and offered active care survived without severe complications. This finding should be considered for individualized parental approaches and decision making. Active follow-up information is required to determine childhood outcomes.
在生存边缘出生的婴儿的存活率仍然很低，并且在新生儿重症监护病房之间差异很大。
通过积极的产前和产后护理，确定 22 或 23 周龄出生的婴儿是否可以提高存活率和改善短期预后。
设计、地点和参与者：回顾性研究了德国科隆大学医学中心三级新生儿重症监护病房于 2010 年 1 月 1 日至 2014 年 12 月 31 日期间出生的 106 名 22 或 23 周龄的婴儿，数据分析于 2015 年 6 月进行。
积极的产前和产后护理。
存活至出院和无新生儿或短期严重并发症存活（定义为高级别脑室出血、腹部并发症手术、支气管肺发育不良或早产儿视网膜病变）。
在 106 例活产婴儿中（45 例 22 周，61 例 23 周零 6 天），20 例（19%）接受姑息治疗（17 例 22 周，3 例 23 周），86 例（81%）接受积极治疗（28 例 22 周，58 例 23 周）。在接受积极治疗的 86 例婴儿中（平均[标准差]母亲年龄为 32[6]岁），58 例（67%）存活至出院（17 例 22 周，41 例 23 周）。85 例婴儿无严重并发症存活，1 例 22 周出生的婴儿因数据缺失而被排除（22 周出生的 6 例，23 周出生的 16 例）。存活由 5 分钟时的阿普加评分（优势比，0.62[95%CI，0.46-0.84]）和出生体重（优势比，0.001[95%CI，0.00-0.40]）预测。
在生存边缘出生的婴儿中，每 4 例接受积极治疗的婴儿中就有 1 例无严重并发症存活。这一发现应考虑用于个体化的父母方法和决策制定。需要进行积极的随访信息以确定儿童结局。
