Department of Paediatrics & Child Health, University of Otago, Wellington, New Zealand.
Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.
Sci Rep. 2017 Oct 6;7(1):12769. doi: 10.1038/s41598-017-12911-5.
Optimal perinatal care of infants born less than 24 weeks gestation remains contentious due to uncertainty about the long-term neurodevelopment of resuscitated infants. Our aim was to determine the short-term mortality and major morbidity outcomes from a cohort of inborn infants born at 23 and 24 weeks gestation and to assess if these parameters differed significantly between infants born at 23 vs. 24 weeks gestation. We report survival rates at 2-year follow-up of 22/38 (58%) at 23 weeks gestation and 36/60 (60%) at 24 weeks gestation. Neuroanatomical injury at the time of discharge (IVH ≥ Grade 3 and/or PVL) occurred in in 3/23 (13%) and 1/40 (3%) of surviving 23 and 24 weeks gestation infants respectively. Rates of disability at 2 years corrected postnatal age were not different between infants born at 23 and 24 weeks gestation. We show evidence that with maximal perinatal care in a tertiary setting it is possible to achieve comparable rates of survival free of significant neuroanatomical injury or severe disability at age 2 in infants born at 23-week and 24-weeks gestation.
由于复苏婴儿的长期神经发育存在不确定性，因此对于 24 周以下出生的婴儿，如何提供最佳围产期护理仍然存在争议。我们的目的是确定 23 周和 24 周出生的婴儿的短期死亡率和主要发病率结果，并评估这些参数在 23 周和 24 周出生的婴儿之间是否存在显著差异。我们报告了 2 年随访时的存活率，23 周时为 38 例中的 22 例（58%），24 周时为 60 例中的 36 例（60%）。在出院时出现的神经解剖损伤（IVH≥3 级和/或 PVL）分别发生在 23 周时存活的 23 例婴儿中的 3 例（13%）和 24 周时存活的 40 例婴儿中的 1 例（3%）。23 周和 24 周出生的婴儿在 2 年校正后出现残疾的比率在统计学上没有差异。我们的研究结果表明，在三级医疗机构中进行最佳围产期护理，可以在 23 周和 24 周出生的婴儿中实现相似的存活率，并且没有明显的神经解剖损伤或严重残疾。
