Haines Morgan, Wright Ian M, Bajuk Barbara, Abdel-Latif Mohamed E, Hilder Lisa, Challis Daniel, Guaran Robert, Oei Ju Lee
School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, Australia.
Acta Paediatr. 2016 Nov;105(11):1305-1311. doi: 10.1111/apa.13503. Epub 2016 Jul 14.
This population-based study determined the delivery room management and outcomes of extremely preterm infants born with Apgar scores of 0.
We linked birth, neonatal intensive care unit (NICU) and death records for babies who were born between 22 + 0 and 27 + 6 weeks of gestation with a one-minute Apgar score of 0, in New South Wales, Australia, between 1998 and 2011.
We classified 2173/2262 (96%) of infants with a one-minute Apgar score of 0 as stillborn. Resuscitation was provided for 48/89 (54%) live births and 40/2173 (2%) stillbirths. Cardiac massage was given to 44 infants, including three 22-week stillborn babies. Of the 13 live births admitted to an NICU, 11 survived to hospital discharge. Most (98%) of the 2212 deaths occurred on the first day of life. One baby who was classified as stillborn lived for 51 days. Resuscitation increased the mean (95% confidence interval) duration of survival from 1 (0-2) to 45 (0-104) hours (p < 0.001). No infant with a five-minute Apgar score of 0 survived.
Clinicians resuscitated extremely preterm infants without a detectable heartbeat, even at 22 weeks of gestation. No infant survived without resuscitation or if their heartbeat was not regained by five minutes.
这项基于人群的研究确定了出生时阿氏评分0分的极早产儿的产房管理及结局。
我们将1998年至2011年间在澳大利亚新南威尔士州出生的妊娠22⁺⁰至27⁺⁶周、1分钟阿氏评分为0分的婴儿的出生记录、新生儿重症监护病房（NICU）记录及死亡记录进行了关联。
我们将2173/2262例（96%）1分钟阿氏评分为0分的婴儿分类为死产。48/89例（54%）活产儿及40/2173例（2%）死产儿接受了复苏。44例婴儿接受了心脏按压，其中包括3例22周的死产儿。入住NICU的13例活产儿中，11例存活至出院。2212例死亡中，大多数（98%）发生在出生首日。1例被分类为死产的婴儿存活了51天。复苏使平均（95%置信区间）存活时间从1（0 - 2）小时增加至45（0 - 104）小时（p < 0.001）。5分钟阿氏评分为0分的婴儿无一存活。
临床医生对即使妊娠22周且无可检测心跳的极早产儿进行了复苏。未接受复苏或5分钟内未恢复心跳的婴儿无一存活。
