Varga Péter, Berecz Botond, Gasparics Ákos, Dombi Zsófia, Varga Zsuzsa, Jeager Judit, Magyar Zsófia, Rigó János, Joó József Gábor, Kornya László
1st Department of Obstetrics and Gynecology Semmelweis University, Budapest, Hungary.
1st Department of Obstetrics and Gynecology Semmelweis University, Budapest, Hungary.
Eur J Obstet Gynecol Reprod Biol. 2017 Apr;211:134-139. doi: 10.1016/j.ejogrb.2017.01.051. Epub 2017 Jan 23.
In this study, we describe trends in morbidity and mortality of preterm infants with less than 500mg birth weight in the changing landscape of obstetric and neonatal care.
During a ten year study period between 2006 and 2016 we assessed outcome data for all neonates with less than 500mg birth weight born at our Neonatal Intensive Care Unit. We divided study subjects into two groups based on whether their birth date fell in the first half (2006-2010; n=39) versus the second half (2011-2015; n=27) of the study period comparing clinical outcomes in the two groups. We also assessed several clinical parameters for association with postnatal survival by comparing relative frequencies for each clinical parameter among surviving infants versus mortality cases.
Survival rate for preterm neonates with less than 500mg birth weight born between 2006 and 2010 was 30.8%. This survival rate rose to 70.4% in the second half of the study period between 2011 and 2015 (p<0.05). Among surviving babies premature birth was found to be predominantly associated with maternal hypertension or intrauterine growth restriction while in those who died premature birth due to premature rupture of membranes and spontaneous preterm labor were significantly more common. All surviving infants with less than 500mg birth weight were born via cesarean section whereas among those who died cesarean section had been performed in only 80% and vaginal delivery in 20% representing a significant difference between the groups (p<0.05). The majority (90.3%) of surviving infants with less than 500mg birth weight had received surfactant therapy while the proportion of neonates receiving surfactant therapy among mortality cases was significantly lower (65.2%; p<0.05).
Our findings suggest that among premature neonates with less than 500mg birth weight preterm delivery due to premature rupture of membranes and intrauterine infections represents the worse mortality risk. Steroid prophylaxis and measures to prevent and treat intrauterine infections with appropriate use of antibiotics can markedly improve survival in these cases. In premature neonates with less than 500mg birth weight survival is more favorable after cesarean section compared to vaginal delivery.
在本研究中，我们描述了出生体重低于500毫克的早产儿在产科和新生儿护理不断变化的背景下的发病和死亡趋势。
在2006年至2016年的十年研究期间，我们评估了在我们新生儿重症监护病房出生的所有出生体重低于500毫克的新生儿的结局数据。我们根据研究对象的出生日期是在研究期的前半段（2006 - 2010年；n = 39）还是后半段（2011 - 2015年；n = 27）将研究对象分为两组，比较两组的临床结局。我们还通过比较存活婴儿与死亡病例中每个临床参数的相对频率，评估了几个临床参数与出生后存活的相关性。
2006年至2010年出生体重低于500毫克的早产儿存活率为30.8%。在2011年至2015年的研究后半期，这一存活率升至70.4%（p < 0.05）。在存活婴儿中，早产主要与母亲高血压或宫内生长受限有关，而在死亡婴儿中，胎膜早破和自发性早产导致的早产明显更为常见。所有出生体重低于500毫克的存活婴儿均通过剖宫产出生，而在死亡婴儿中，仅80%进行了剖宫产，20%为阴道分娩，两组之间存在显著差异（p < 0.05）。出生体重低于500毫克的存活婴儿中，大多数（90.3%）接受了表面活性剂治疗，而在死亡病例中接受表面活性剂治疗的新生儿比例明显较低（65.2%；p < 0.05）。
我们的研究结果表明，在出生体重低于500毫克的早产儿中，胎膜早破和宫内感染导致的早产代表着更高的死亡风险。使用类固醇预防以及采取预防和治疗宫内感染的措施并合理使用抗生素可显著提高这些病例的存活率。与阴道分娩相比，剖宫产对出生体重低于500毫克的早产儿的存活更有利。
