Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Maternité Olympe de Gouges, Regional Univeristy Hospital, François Rabelais University, Tours, France.
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Service de Néonatologie Hopital Armand Trousseau, APHP, Pierre et Marie Curie University, Paris, France.
J Pediatr. 2018 Dec;203:150-155. doi: 10.1016/j.jpeds.2018.07.072. Epub 2018 Sep 27.
To evaluate the association between active antenatal management and neonatal outcomes in extremely preterm newborns admitted to a neonatal intensive care unit (NICU).
This population-based cohort study was conducted in 25 regions of France. Infants born in 2011 between 22 and 26 weeks of gestation and admitted to a NICU were included. Infants with lethal congenital malformations or death in the delivery room were excluded. A multilevel multivariable analysis was performed, accounting for clustering by mother (multiple pregnancies) and hospital plus individual characteristics, to estimate the association between the main exposure of no active antenatal management (not receiving antenatal corticosteroids, magnesium sulfate, or cesarean delivery for fetal indications) and a composite outcome of death or severe neonatal morbidity (including severe forms of brain or lung injury, retinopathy of prematurity, and necrotizing enterocolitis).
Among 3046 extremely preterm births, 783 infants were admitted to a NICU. Of these, 138 (18%) did not receive active antenatal management. The risk of death or severe morbidity was significantly higher for infants without active antenatal management (crude OR, 2.60; 95% CI, 1.44-4.66). This finding persisted after adjustment for gestational age (OR, 2.08; 95% CI, 1.19-3.62) and all confounding factors (OR, 1.86; 95% CI, 1.09-3.20).
The increased risk of severe neonatal outcomes for extremely preterm babies admitted to a NICU without optimal antenatal management should be considered in individual-level decision making and in the development of professional guidelines for the management of extremely preterm births.
评估在新生儿重症监护病房（NICU）收治的极早产儿中，积极产前管理与新生儿结局之间的关系。
本基于人群的队列研究在法国的 25 个地区进行。纳入 2011 年在 22-26 孕周出生且入住 NICU 的婴儿。排除存在致死性先天性畸形或分娩室死亡的婴儿。采用多水平多变量分析，考虑到母亲（多胎妊娠）和医院加个体特征的聚类，估计主要暴露因素（未接受产前皮质激素、硫酸镁或因胎儿指征行剖宫产）与死亡或严重新生儿发病率（包括严重脑或肺损伤、早产儿视网膜病变和坏死性小肠结肠炎）的复合结局之间的关联。
在 3046 例极早产儿中，有 783 例婴儿入住 NICU。其中，138 例（18%）未接受积极的产前管理。未接受积极产前管理的婴儿死亡或严重发病的风险显著增加（粗比值比，2.60；95%置信区间，1.44-4.66）。在调整胎龄（比值比，2.08；95%置信区间，1.19-3.62）和所有混杂因素（比值比，1.86；95%置信区间，1.09-3.20）后，这一发现仍然存在。
对于入住 NICU 的极早产儿，如果没有最佳的产前管理，严重新生儿结局的风险增加，这应该在个体层面的决策中考虑，并在制定极早产儿管理的专业指南中考虑。
