Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Melbourne, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2021 Aug;61(4):528-535. doi: 10.1111/ajo.13309. Epub 2021 Feb 16.
Management of livebirths at 22-24 weeks' gestation in high-income countries varies widely and has changed over time.
Our aim was to determine how rates of active management and infant survival of livebirths at 22-24 weeks varied with perinatal variables known at birth, and over time in Victoria, Australia.
We conducted a population-based cohort study of all 22-24 weeks' gestation live births, free of lethal congenital anomalies in 2009-2017. Rates of active management and survival to one year of age were reported. 'Active management' was defined as receiving resuscitation at birth or nursery admission for intensive care.
Over the nine-year period, there were 796 eligible live births. Overall, 438 (55%) were actively managed: 5% at 22 weeks, 45% at 23 weeks and 90% at 24 weeks' gestation, but rates of active management did not vary substantially over time. Of livebirths actively managed, 263 (60%) survived to one year: 0% at 22 weeks, 50% at 23 weeks and 66% at 24 weeks. Apart from gestational age, being born in a tertiary perinatal centre and increased size at birth were associated with survival in those actively managed, but sex and plurality were not. Survival rates of actively managed infants rose over time (adjusted odds ratio 1.09 per year; 95% CI 1.01-1.18; P = 0.03).
Although active management rates did not change substantially over time in Victoria, an overall increase in infant survival was observed. With increasing gestational age, rates of active management and infant survival rapidly rose.
高收入国家 22-24 周龄活产儿的管理方式差异很大，且随时间推移而发生变化。
我们旨在确定在澳大利亚维多利亚州，已知出生时围产变量和随时间推移的情况下，22-24 周龄活产儿积极管理率和婴儿存活率如何变化。
我们对 2009 年至 2017 年所有 22-24 周龄无致死性先天性畸形的活产儿进行了一项基于人群的队列研究。报告了积极管理和存活至 1 岁的比率。“积极管理”定义为出生时接受复苏或新生儿重症监护病房（NICU）入住接受强化护理。
在九年期间，共有 796 例符合条件的活产儿。总体而言，438 例（55%）接受了积极管理：22 周时为 5%，23 周时为 45%，24 周时为 90%，但随时间推移，积极管理率没有显著变化。在接受积极管理的活产儿中，263 例（60%）存活至 1 岁：22 周时为 0%，23 周时为 50%，24 周时为 66%。除胎龄外，在三级围产中心出生和出生时的大小增加与积极管理的存活有关，但性别和多胎无关。接受积极管理的婴儿存活率随时间推移而上升（调整后的优势比每年增加 1.09；95%CI 1.01-1.18；P=0.03）。
尽管在维多利亚州，随时间推移，积极管理率没有显著变化，但观察到婴儿存活率总体上升。随着胎龄的增加，积极管理率和婴儿存活率迅速上升。
