Division of Neonatology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA.
Division of Neonatology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA.
J Pediatr. 2020 Feb;217:52-58.e1. doi: 10.1016/j.jpeds.2019.08.028. Epub 2019 Oct 9.
To assess the outcomes in actively managed extremely preterm infants after admission to a neonatal intensive care unit.
Retrospective cohort of 255 infants born at 22-25 weeks of gestation between 2006 and 2015 at a single study institution. Infants were excluded for congenital anomaly, death in delivery room, or parental request for palliation (n = 7). Neurodevelopmental outcomes were analyzed for 169 of 214 survivors (78.9%) at 18-22 months of corrected age. Outcomes were evaluated using the Mann-Whitney U, χ, or Fisher exact test, where appropriate. In addition, cognitive scores of the Bayley Scales of Infant-Toddler Development (3rd edition) were assessed using generalized estimating equations.
Seventy infants born at 22-23 weeks of gestation (22 weeks, n = 20; 23 weeks, n = 50) and 178 infants born at 24-25 weeks of gestation (24 weeks, n = 79; 25 weeks, n = 99 infants) were included. Survival to hospital discharge of those surviving to NICU admission was 78% (55/70; 95% CI, 69%-88%) at 22-23 weeks and 89% (159/178; 95% CI, 84%-93% at 24-25 weeks; P = .02). No or mild neurodevelopmental impairment in surviving infants was 64% (29/45; 95% CI, 50%-77%) at 22-23 weeks and 76% (94/124; 95% CI, 68%-83%; P = .16) at 24-25 weeks.
Although survival was lower in infants born at 22-23 weeks than at 24-25 weeks of gestation, the majority of survivors in both groups had positive outcomes with no or mild neurodevelopmental impairments. Further evaluation of school performance is warranted.
评估入住新生儿重症监护病房的积极管理的极早产儿的结局。
对 2006 年至 2015 年在单家研究机构出生的 22-25 周龄的 255 名婴儿进行回顾性队列研究。排除了先天性异常、产房死亡或父母要求姑息治疗的婴儿（n=7）。在 18-22 个月的校正年龄时，对 214 名幸存者中的 169 名（78.9%）进行了神经发育结局分析。使用 Mann-Whitney U、χ²或 Fisher 确切检验（如果适用）分析结果。此外，使用广义估计方程评估婴儿-学步儿发展量表（第 3 版）的认知评分。
22-23 周龄时纳入 70 名婴儿（22 周龄，n=20；23 周龄，n=50），24-25 周龄时纳入 178 名婴儿（24 周龄，n=79；25 周龄，n=99 名婴儿）。存活至 NICU 入院的患儿出院存活率为 78%（55/70；95%CI，69%-88%），24-25 周时为 89%（159/178；95%CI，84%-93%；P=0.02）。存活婴儿的无或轻度神经发育障碍率为 64%（29/45；95%CI，50%-77%），24-25 周时为 76%（94/124；95%CI，68%-83%；P=0.16）。
尽管 22-23 周龄出生的婴儿存活率低于 24-25 周龄，但两组存活婴儿中，大多数存活婴儿的结局为无或轻度神经发育障碍。进一步评估其在校表现是必要的。
