Department of Neonatology, Guangxi Maternal and Child Health Hospital, Nanning, 530003, Guangxi, China.
Department of Neonatology, Guangxi Maternal and Child Health Hospital, Nanning, 530003, Guangxi, China.
Early Hum Dev. 2019 Jun;133:5-10. doi: 10.1016/j.earlhumdev.2019.04.002. Epub 2019 Apr 13.
To assess treatment outcomes and associated factors of extremely preterm infants (EPIs) in GuangXi, China.
This was a retrospective study consisting of 131 eligible cases with gestational age (GA) between 22 and 28 weeks, and infants were followed until 18-24 months. Data including clinical characteristics, perinatal factors and after-birth conditions were collected from the neonatal intensive care unit in 10 hospitals in Guangxi from January 1st 2010 until May 31st 2016.
During that period, 307 EPIs were born in the hospitals. 137 infants died in hospital after their parents decided to withdraw clinical treatment, and 11 infants died despite full resuscitation was provided. Of the 159 surviving infants, 28 infants were lost to follow-up. In total, 131 infants who survived and were presented to follow-up at 18-24 months of age were enrolled into this study. Of the 131 infants evaluated at 18-24 months follow-up, 47 (35.9%) were diagnosed with neurodevelopmental disability (ND), and 84 (64%) demonstrated on tract motor and language skills. The incidence of chorioamnionitis, early onset sepsis (EOS), bronchopulmonary dysplasia (BPD) were all higher in the group of infants who were diagnosed with ND compared to those with normal motor language development (NML), the duration of mechanical ventilation (MV) was longer in ND group, and the higher incidence of ND was seen in the smaller GA babies (p < 0.05). Adjusted the BPD severity, GA was a protective factor of neurodevelopmental outcome (combined OR = 0.338, 95% CI: 0.145-0.791). In EPIs with moderate BPD and severe BPD, chorioamnionitis was a risk factor of ND (OR = 10.313 and 5.778，respectively, 95% CI: 1.389-6.486 and 1.444-23.119, respectively). The Logistic regression analysis showed that GA (OR = 0.207, 95%CI = 0.047-0.917) was a protective factor for ND, and chorioamnionitis (OR = 6.010, 95%CI: 1.331-27.138), moderate-to-severe BPD (OR = 4.285, 95%CI: 1.495-12.287), the duration of MV (OR = 3.508, 95%CI: 2.077-5.926) were independent risk factors for ND in EPIs.
Chorioamnionitis, moderate-to-severe BPD, and the duration of MV were associated with neurodevelopmental disability in EPIs. The smaller the GA, the higher incidence of neurodevelopmental disability.
评估中国广西地区极早产儿（EPI）的治疗结局及其相关因素。
这是一项回顾性研究，纳入了 131 名符合条件的病例，其胎龄（GA）为 22 至 28 周，并随访至 18-24 个月。从 2010 年 1 月 1 日至 2016 年 5 月 31 日，广西 10 家医院的新生儿重症监护病房收集了包括临床特征、围产期因素和产后情况在内的数据。
在此期间，10 家医院共出生了 307 名 EPI。其中 307 名 EPI 中，有 137 名婴儿在其父母决定停止临床治疗后在医院死亡，11 名婴儿尽管进行了充分的复苏仍死亡。在 159 名幸存婴儿中，有 28 名婴儿失访。共有 131 名幸存且在 18-24 个月时进行随访的婴儿被纳入本研究。在 18-24 个月的随访中，有 47 名（35.9%）婴儿被诊断为神经发育障碍（ND），84 名（64%）婴儿在运动和语言技能方面表现出 ND。与运动语言发育正常（NML）的婴儿相比，患有 ND 的婴儿中绒毛膜羊膜炎、早发性败血症（EOS）和支气管肺发育不良（BPD）的发生率均更高，机械通气（MV）时间更长，GA 越小，ND 的发生率越高（p<0.05）。调整 BPD 严重程度后，GA 是神经发育结局的保护因素（合并 OR=0.338，95%CI：0.145-0.791）。在患有中度和重度 BPD 的 EPI 中，绒毛膜羊膜炎是 ND 的危险因素（OR=10.313 和 5.778，95%CI：1.389-6.486 和 1.444-23.119）。Logistic 回归分析显示，GA（OR=0.207，95%CI=0.047-0.917）是 ND 的保护因素，而绒毛膜羊膜炎（OR=6.010，95%CI：1.331-27.138）、中重度 BPD（OR=4.285，95%CI：1.495-12.287）、MV 时间（OR=3.508，95%CI：2.077-5.926）是 EPI 发生 ND 的独立危险因素。
绒毛膜羊膜炎、中重度 BPD 和 MV 时间与 EPI 的 ND 有关。GA 越小，ND 的发生率越高。
