Park Jae Hyun, Chang Yun Sil, Sung Sein, Ahn So Yoon, Park Won Soon
Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
PLoS One. 2017 Jan 23;12(1):e0170220. doi: 10.1371/journal.pone.0170220. eCollection 2017.
To investigate the trends in mortality, as well as in the timing and cause of death, among extremely preterm infants at the limit of viability, and thus to identify the clinical factors that contribute to decreased mortality.
We retrospectively reviewed the medical records of 382 infants born at 23-26 weeks' gestation; 124 of the infants were born between 2001 and 2005 (period I) and 258 were born between 2006 and 2011 (period II). We stratified the infants into two subgroups-"23-24 weeks" and "25-26 weeks"-and retrospectively analyzed the clinical characteristics and mortality in each group, as well as the timing and cause of death. Univariate and multivariate logistic regression analyses were done to identify the clinical factors associated with mortality.
The overall mortality rate in period II was 16.7% (43/258), which was significantly lower than that in period I (30.6%; 38/124). For overall cause of death, there were significantly fewer deaths due to sepsis (2.4% [6/258] vs. 8.1% [10/124], respectively) and air-leak syndrome (0.8% [2/258] vs. 4.8% (6/124), respectively) during period II than during period I. Among the clinical factors of time period, 1-and 5-min Apgar score, antenatal steroid identified significant by univariate analyses. 5-min Apgar score and antenatal steroid use were significantly associated with mortality in multivariate analyses.
Improved mortality rate attributable to fewer deaths due to sepsis and air leak syndrome in the infants with 23-26 weeks' gestation was associated with higher 5-minute Apgar score and more antenatal steroid use.
调查存活极限边缘的极早产儿的死亡率、死亡时间及死因趋势，从而确定导致死亡率降低的临床因素。
我们回顾性分析了382例孕23 - 26周出生婴儿的病历；其中124例婴儿在2001年至2005年出生（第一阶段），258例在2006年至2011年出生（第二阶段）。我们将婴儿分为两个亚组——“23 - 24周”和“25 - 26周”——并回顾性分析每组的临床特征、死亡率以及死亡时间和死因。进行单因素和多因素逻辑回归分析以确定与死亡率相关的临床因素。
第二阶段的总体死亡率为16.7%（43/258），显著低于第一阶段（30.6%；38/124）。对于总体死因，第二阶段因败血症死亡的人数（分别为2.4% [6/258] 和8.1% [10/124]）以及因气漏综合征死亡的人数（分别为0.8% [2/258] 和4.8% [6/124]）均显著少于第一阶段。在时间段的临床因素中，单因素分析显示1分钟和5分钟阿氏评分、产前使用类固醇有显著意义。多因素分析显示5分钟阿氏评分和产前使用类固醇与死亡率显著相关。
孕23 - 26周婴儿因败血症和气漏综合征导致的死亡减少，死亡率得到改善，这与较高的5分钟阿氏评分和更多的产前类固醇使用有关。
