2008-2017 年广东省多中心研究：极早产儿出院时的短期结局。
Short-term outcomes of extremely preterm infants at discharge: a multicenter study from Guangdong province during 2008-2017.
机构信息
Department of Neonatology, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
Department of Pediatrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China.
出版信息
BMC Pediatr. 2019 Nov 4;19(1):405. doi: 10.1186/s12887-019-1736-8.
BACKGROUND
An increasing number of extremely preterm (EP) infants have survived worldwide. However, few data have been reported from China. This study was designed to investigate the short-term outcomes of EP infants at discharge in Guangdong province.
METHODS
A total of 2051 EP infants discharged from 26 neonatal intensive care units during 2008-2017 were enrolled. The data from 2008 to 2012 were collected retrospectively, and from 2013 to 2017 were collected prospectively. Their hospitalization records were reviewed.
RESULTS
During 2008-2017, the mean gestational age (GA) was 26.68 ± 1.00 weeks and the mean birth weight (BW) was 935 ± 179 g. The overall survival rate at discharge was 52.5%. There were 321 infants (15.7%) died despite active treatment, and 654 infants (31.9%) died after medical care withdrawal. The survival rates increased with advancing GA and BW (p < 0.001). The annual survival rate improved from 36.2% in 2008 to 59.3% in 2017 (p < 0.001). EP infants discharged from hospitals in Guangzhou and Shenzhen cities had a higher survival rate than in others (p < 0.001). The survival rate of EP infants discharged from general hospitals was lower than in specialist hospitals (p < 0.001). The major complications were neonatal respiratory distress syndrome, 88.0% (1804 of 2051), bronchopulmonary dysplasia, 32.3% (374 of 1158), retinopathy of prematurity (any grade), 45.1% (504 of 1117), necrotizing enterocolitis (any stage), 10.1% (160 of 1588), intraventricular hemorrhages (any grade), 37.4% (535 of 1431), and blood culture-positive nosocomial sepsis, 15.7% (250 of 1588). The multivariate logistic regression analysis indicated that improved survival of EP infants was associated with discharged from specialist hospitals, hospitals located in high-level economic development region, increasing gestational age, increasing birth weight, antenatal steroids use and a history of premature rupture of membranes. However, twins or multiple births, Apgar ≤7 at 5 min, cervical incompetence, and decision to withdraw care were associated with decreased survival.
CONCLUSIONS
Our study revealed the short-term outcomes of EP infants at discharge in China. The overall survival rate was lower than the developed countries, and medical care withdrawal was a serious problem. Nonetheless, improvements in care and outcomes have been made annually.
背景
全世界范围内，存活下来的极早产儿（extremely preterm，EP）数量逐渐增加。然而，中国的相关数据却很少报道。本研究旨在调查广东省 EP 婴儿出院时的短期结局。
方法
共纳入 2008 年至 2017 年期间 26 个新生儿重症监护病房出院的 2051 例 EP 婴儿。2008 年至 2012 年的数据为回顾性收集，2013 年至 2017 年的数据为前瞻性收集。回顾了他们的住院记录。
结果
2008 年至 2017 年，平均胎龄（gestational age，GA）为 26.68±1.00 周，平均出生体重（birth weight，BW）为 935±179 g。出院时总体存活率为 52.5%。尽管积极治疗，仍有 321 例（15.7%）婴儿死亡，654 例（31.9%）婴儿在放弃治疗后死亡。存活率随 GA 和 BW 的增加而提高（p<0.001）。每年的存活率从 2008 年的 36.2%提高到 2017 年的 59.3%（p<0.001）。来自广州和深圳的 EP 婴儿的存活率高于其他地区（p<0.001）。来自综合医院的 EP 婴儿的存活率低于专科医院（p<0.001）。主要并发症为新生儿呼吸窘迫综合征，88.0%（1804/2051），支气管肺发育不良，32.3%（374/1158），早产儿视网膜病变（任何程度），45.1%（504/1117），坏死性小肠结肠炎（任何阶段），10.1%（160/1588），颅内出血（任何程度），37.4%（535/1431），血培养阳性的院内败血症，15.7%（250/1588）。多因素 logistic 回归分析表明，EP 婴儿存活率的提高与专科医院出院、高水平经济发展地区医院、GA 增加、BW 增加、产前使用类固醇和胎膜早破史有关。然而，双胞胎或多胎、5 分钟时 Apgar 评分≤7、宫颈机能不全和放弃治疗的决定与存活率降低有关。
结论
本研究揭示了中国 EP 婴儿出院时的短期结局。总体存活率低于发达国家，且放弃治疗是一个严重的问题。尽管如此，每年的治疗和结局都有所改善。
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