22-23 孕周出生新生儿的死亡和神经发育损伤的危险因素。

Risk Factors for Mortality and Neurodevelopmental Impairment among Neonates Born at 22-23 Weeks' Gestation.

机构信息

Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan,

Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.

出版信息

Neonatology. 2021;118(3):310-316. doi: 10.1159/000514161. Epub 2021 Mar 19.

DOI:10.1159/000514161

PMID:33744873

Abstract

INTRODUCTION

We aimed to evaluate the risk factors for mortality and neurodevelopmental impairment (NDI) among infants of 22-23 weeks' gestational age, which currently remain unclear.

METHODS

This retrospective case-control study included 104 infants delivered at 22-23 weeks' gestation at Kagoshima City Hospital from 2006 to 2015. We compared 65 and 34 cases of survival to discharge and postnatal in-hospital death (5 excluded), respectively, and 26 and 35 cases with and without NDI, respectively, using maternal, prenatal, and postnatal records. A high rate of survivors' follow-up (61/65) was achieved in this study.

RESULTS

The survival rate was 75.0% (21/28) and 62.0% (44/71) among infants born at 22 and 23 weeks' gestation, respectively. Infants who died weighed less (525.5 vs. 578 g, p = 0.04) and their intrauterine growth retardation (IUGR) rate (<5th percentile) was higher (14.7 vs. 1.5%, p = 0.02). Mortality was associated with an increased incidence of bradycardia on fetal heart rate monitoring (11.8 vs. 1.5%, p = 0.046), periventricular hemorrhagic infarction (PVHI; 32.4 vs. 6.2%, p = 0.001), necrotizing enterocolitis (NEC, surgery or drain tube; 14.7 vs. 0.0%, p = 0.004), and tension pneumothorax (29.4 vs. 6.2%, p = 0.004). There were significant differences in the proportion of PVHI (15.4 vs. 0%, p = 0.03) between infants with and without NDI.

CONCLUSIONS

IUGR, bradycardia, PVHI, NEC, and tension pneumothorax were associated with neonatal mortality among infants born at 22-23 weeks' gestation. NDI at 36-42 months' chronological age was associated with PVHI.

摘要

介绍

我们旨在评估 22-23 孕周婴儿的死亡率和神经发育障碍（NDI）的风险因素，目前这些因素尚不清楚。

方法

这是一项回顾性病例对照研究，纳入了 2006 年至 2015 年在鹿儿岛市医院分娩的 22-23 孕周的 104 例婴儿。我们比较了分别存活至出院和院内死亡（5 例除外）的 65 例和 34 例，以及分别无和有 NDI 的 26 例和 35 例，使用了母亲、产前和产后的记录。本研究实现了高比例的幸存者随访（61/65）。

结果

22 周和 23 周出生的婴儿存活率分别为 75.0%（21/28）和 62.0%（44/71）。死亡的婴儿体重较轻（525.5 克比 578 克，p=0.04），宫内生长受限（IUGR；<第 5 百分位数）发生率较高（14.7%比 1.5%，p=0.02）。死亡率与胎儿心率监测中心动过缓的发生率增加（11.8%比 1.5%，p=0.046）、脑室内出血性梗死（PVHI；32.4%比 6.2%，p=0.001）、坏死性小肠结肠炎（NEC，手术或引流管；14.7%比 0.0%，p=0.004）和张力性气胸（29.4%比 6.2%，p=0.004）有关。有和无 NDI 的婴儿的 PVHI 比例（15.4%比 0%，p=0.03）有显著差异。