Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Arch Dis Child Fetal Neonatal Ed. 2021 May;106(3):251-257. doi: 10.1136/archdischild-2020-318978. Epub 2020 Nov 6.
In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25 to 24 weeks' gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation.
National cohort study, using data from the Netherlands Perinatal Registry.
The study population included all 3312 stillborn and live born infants with a gestational age (GA) between 24 and 26 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group.
Survival to discharge, as well as cause and timing of death.
After guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks' GA (27%-69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%-34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011-2014 to 23% in 2015-2017, p=0.006).
Implementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks' GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.
2010 年，荷兰将自发性分娩主动治疗的门槛从 25 周降低至 24 周。本研究旨在评估指南实施对实施后几年内存活以及死亡原因和时间的影响。
使用荷兰围产期登记处的数据进行全国队列研究。
研究人群包括所有在 2011 年 1 月至 2017 年 12 月之间出生的胎龄（GA）在 24 至 26 周之间的所有死产和活产婴儿，共 3312 例。将 2007 年 1 月至 2009 年 12 月出生的 GA 相同的婴儿（N=1400）作为参考组。
出院时的存活率，以及死亡原因和时间。
指南实施后，24 周 GA 活产婴儿的新生儿重症监护病房（NICU）入院率显著增加（27%-69%，p<0.001），导致 24 周 GA 活产婴儿的存活率提高（13%-34%，p<0.001）。住院内死亡的前三大原因是坏死性小肠结肠炎（28%）、呼吸窘迫综合征（19%）和脑室出血（17%）。随着时间的推移，呼吸功能不全引起或导致的死亡原因明显减少（2011-2014 年为 34%，2015-2017 年为 23%，p=0.006）。
2010 年指南的实施如预期的那样增加了 24 周 GA 出生婴儿的 NICU 入院率和产后存活率。在实施后的几年中，死亡原因从呼吸功能不全转向坏死性小肠结肠炎和败血症。
