Departments of Pediatrics,
Department of Pediatrics, University of California San Diego, La Jolla, California.
Pediatrics. 2016 Jul;138(1). doi: 10.1542/peds.2015-4434. Epub 2016 Jun 14.
To assess the rates of mortality and major morbidity among extremely preterm infants born in California and to examine the rates of neonatal interventions and timing of death at each gestational age.
A retrospective cohort study of all California live births from 2007 through 2011 linked to vital statistics and hospital discharge records, whose best-estimated gestational age at birth was 22 through 28 weeks. Major morbidities were based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Survival beyond the first calendar day of life and procedure codes were used to assess attempted resuscitation after birth.
A total of 6009 infants born at 22 through 28 weeks' gestation were included. Survival to 1 year for all live births ranged from 6% at 22 weeks to 94% at 28 weeks. Seventy-three percent of deaths occurred within the first week of life. Major morbidity was present in 80% of all infants, and multiple major morbidities were present in 66% of 22- and 23-week infants. Rates of resuscitation at 22, 23, and 24 weeks were 21%, 64%, and 93%, respectively. Survival after resuscitation was 31%, 42%, and 64% among 22-, 23-, and 24-week infants, respectively. Improved survival was associated with increased birth weight, female sex, and cesarean delivery (P < .01) for resuscitated 22-, 23-, and 24-week infants.
In a population-based study of extreme prematurity, infants ≤24 weeks' gestation are at highest risk of death or major morbidity. These data can help inform recommendations and decision-making for extremely preterm births.
评估加利福尼亚州极早产儿的死亡率和主要发病率，并检查每个胎龄的新生儿干预措施和死亡时间的发生率。
这是一项回顾性队列研究，对 2007 年至 2011 年期间加利福尼亚州所有活产婴儿进行研究，这些婴儿的最佳估计胎龄为 22 至 28 周，并与生命统计数据和医院出院记录相关联。主要发病率是基于国际疾病分类，第九版，临床修正版的代码。在生命的第一个日历日后的生存情况和程序代码用于评估出生后的复苏尝试。
共纳入 6009 名胎龄为 22 至 28 周的婴儿。所有活产婴儿的 1 年生存率从 22 周的 6%到 28 周的 94%不等。73%的死亡发生在生命的第一周内。80%的婴儿存在主要发病率，22 周和 23 周的 66%的婴儿存在多种主要发病率。22、23 和 24 周的复苏率分别为 21%、64%和 93%。在接受复苏的 22、23 和 24 周的婴儿中，复苏后的生存率分别为 31%、42%和 64%。
在一项基于人群的极早产研究中，胎龄≤24 周的婴儿死亡或主要发病率的风险最高。这些数据可以帮助为极早产儿的出生提供建议和决策。
