Abolfotouh Mostafa A, Al Saif Saif, Altwaijri Waleed A, Al Rowaily Mohammed A
Research Training and Development Section, King Abdullah International Medical Research Center, King Saud bin-Abdulaziz University for Health Sciences - Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
King Abdulaziz Medical City, King Saud bin-Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
BMC Pediatr. 2018 Aug 22;18(1):280. doi: 10.1186/s12887-018-1248-y.
Survival of preterm neonates has steadily improved over the past five decades, due to changes in the neonatal intensive care. However, in Saudi Arabia, there are no written guidelines on the definition of the lower limit of viability, and there has been a call for such a limit. The aims of this study were: (1) to determine lower limits of viability and survival in extremely low birthweight (ELBW) infants, and (2) to determine incidence of neurodevelopmental and cognitive abnormalities within 3-6 years after birth.
Prospective study of all live inborn ELBW infants admitted to the neonatal unit of King Abdulaziz Medical City, Riyadh, Saudi Arabia, within 3 years [between January 1st, 2005 and December 31st, 2007] was conducted (n = 117). Data were collected on demographic and birth data, neonatal complications & interventions and death on discharge. Prospective follow up of all survivors was done, within 6 years after birth, to assess the outcome in terms of neurodevelopmental and cognitive abnormalities. Predictors of survival were determined using logistic regression model. Significance was considered at p-value ≤0.05.
Of all ELBW infants, 41% died before discharge. Survival rate was directly correlated with gestational age (GA) and birthweight (p < 0.05). The 50% limits of viability were those at 25 weeks' gestation or with > 600 g. After adjusting for possible confounders, significant predictors of survival were birthweight (p = 0.001) and Apgar score (p < 0.001). The following impairments were reported during follow up of survivors: developmental delay (39.2%), cerebral palsy (36.2%), speech problems (33.3%), wasting (12.5%), intellectual disability (10%), visual problems (6.6%) and hyperactivity (5.6%).
More than one-third of ELBW died before discharge from NICU, and two-thirds of survivors had one or more neurodevelopmental and/or cognitive abnormalities during their first 6 years of life. The 50% limits of viability of ELBW infants were those at week 25 of gestation or with a birthweight of more than 600 g. Birthweight could be considered as more valid than gestational age in the prediction of viability of ELBW infants. The process of care of ELBW infants in Saudi Arabia may need to be revisited taking these findings into consideration.
由于新生儿重症监护的变革，过去五十年来早产新生儿的存活率稳步提高。然而，在沙特阿拉伯，关于生存能力下限的定义尚无书面指南，且一直有人呼吁设定这样的下限。本研究的目的是：（1）确定极低出生体重（ELBW）婴儿的生存能力下限和存活率，以及（2）确定出生后3至6年内神经发育和认知异常的发生率。
对2005年1月1日至2007年12月31日这3年内入住沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城新生儿科的所有存活的ELBW活产婴儿进行前瞻性研究（n = 117）。收集了人口统计学和出生数据、新生儿并发症及干预措施以及出院时死亡情况的数据。对所有幸存者在出生后6年内进行前瞻性随访，以评估神经发育和认知异常方面的结局。使用逻辑回归模型确定存活的预测因素。p值≤0.05时认为具有统计学意义。
在所有ELBW婴儿中，41%在出院前死亡。存活率与胎龄（GA）和出生体重直接相关（p < 0.05）。生存能力的50%界限是妊娠25周或出生体重>600克。在对可能的混杂因素进行调整后，存活的显著预测因素是出生体重（p = 0.001）和阿氏评分（p < 0.001）。在对幸存者的随访中报告了以下损害情况：发育迟缓（39.2%）、脑瘫（36.2%）、言语问题（33.3%）、消瘦（12.5%）、智力残疾（10%）、视力问题（6.6%）和多动（5.6%）。
超过三分之一的ELBW婴儿在新生儿重症监护病房出院前死亡，三分之二的幸存者在其生命的前6年中有一种或多种神经发育和/或认知异常。ELBW婴儿生存能力的50%界限是妊娠第25周或出生体重超过600克。在预测ELBW婴儿的生存能力方面，出生体重可能比胎龄更具参考价值。考虑到这些发现，沙特阿拉伯ELBW婴儿的护理过程可能需要重新审视。
