Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
Department of Neonatology, Affiliated Bayi Children's Hospital, Seventh Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.
JAMA Netw Open. 2021 May 3;4(5):e219382. doi: 10.1001/jamanetworkopen.2021.9382.
Extreme prematurity is associated with a substantial burden on health care systems worldwide. However, little is known about the prognosis of infants born extremely preterm in developing countries, such as China.
To describe survival and major morbidity among infants born extremely preterm in China over the past decade.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted from January 1, 2010, through December 31, 2019. Included individuals were infants with gestational age less than 28 weeks discharged from 1 of 68 neonatal intensive care units located in 31 provinces in China. Data were analyzed from August through October 2020.
Extremely preterm birth.
Survival to discharge and major morbidity (ie, bronchopulmonary dysplasia, grades III-IV intraventricular hemorrhage, white matter injury, stage II-III necrotizing enterocolitis, sepsis, or severe retinopathy of prematurity) were measured.
Among 8514 eligible infants, 5295 (62.2%) were male and 116 infants (2.0%) were small for gestational age (SGA). Overall, 5302 infants (62.3%) survived to discharge. The survival rate was 1 of 21 infants (4.8%) at 22 weeks, 13 of 71 infants (18.3%) at 23 weeks, 144 of 408 infants (35.3%) at 24 weeks, 480 of 987 infants (48.6%) at 25 weeks, 1423 of 2331 infants (61.0%) at 26 weeks, and 3241 of 4692 infants (69.1%) at 27 weeks. Survival increased from 136 of 241 infants (56.4%; 95% CI, 50.1%-62.7%) in 2010 to 1110 of 1633 infants (68.0%; 95% CI, 65.7%-70.2%) in 2019 for infants born at 24 to 27 weeks (mean difference, 11.5%; 95% CI, 4.9%-18.2%; P < .001), without a significant change for infants born at less than 24 weeks. Major morbidity was found in 5999 of 8281 infants overall, for a rate of 72.4%, which increased from 116 of 223 infants (52.0%; 95% CI, 45.4%-58.6%) to 1363 of 1656 infants (82.3%; 95% CI, 80.5%-84.1%) from 2010 to 2019 (mean difference, 30.3%; 95% CI, 23.5%-37.1%, P < .001). Regional variations in survival were identified, with an almost 2-fold increase (1.94-fold; 95% CI, 1.66-2.27; P < .001) from 188 of 474 infants (39.7%) in northwest China to 887 of 1153 infants (76.9%) in north China. Gestational age (adjusted risk ratio [aRR], 1.084; 95% CI, 1.063-1.105; P < .001), birth weight (aRR, 1.028; 95% CI, 1.020-1.036; P < .001), premature rupture of membranes (aRR, 1.025; 95% CI, 1.002-1.048; P = .03), and antenatal steroids (aRR, 1.029; 95% CI, 1.004-1.055; P = .02) were associated with improved survival, while being born SGA (aRR, 0.801; 95% CI, 0.679-0.945; P = .01), being male (aRR, 0.975; 95% CI, 0.954-0.997; P = .02), multiple birth (aRR, 0.955; 95% CI, 0.929-0.982; P = .001), having a mother with gestational diabetes (aRR, 0.946; 95% CI, 0.913-0.981; P = .002), and low Apgar score (aRR, 0.951; 95% CI, 0.925-0.977; P < .001) were found to be risk factors associated with decreased chances of survival.
This study found that infants born extremely preterm were at increased risk of mortality and morbidity in China, with a survival rate that improved over time and a major morbidity rate that increased. These findings suggest that more active and effective treatment strategies are needed, especially for infants born at gestational age 25 to 27 weeks.
极早产与全球医疗保健系统负担沉重有关。然而，对于中国等发展中国家极早产儿的预后知之甚少。
描述中国过去十年中极早产儿的生存和主要发病率。
设计、地点和参与者：本回顾性队列研究于 2010 年 1 月 1 日至 2019 年 12 月 31 日进行。纳入标准为胎龄小于 28 周、从中国 31 个省的 68 个新生儿重症监护病房出院的婴儿。数据分析于 2020 年 8 月至 10 月进行。
极早产。
测量存活率和主要发病率（即支气管肺发育不良、III-IV 级脑室内出血、白质损伤、II-III 级坏死性小肠结肠炎、败血症或严重早产儿视网膜病变）。
在 8514 名符合条件的婴儿中，5295 名（62.2%）为男性，116 名（2.0%）为小于胎龄儿（SGA）。总体而言，5302 名（62.3%）婴儿存活至出院。存活率为 1 例（4.8%）的婴儿在 22 周，13 例（18.3%）的婴儿在 23 周，408 例（35.3%）的婴儿在 24 周，987 例（48.6%）的婴儿在 25 周，2331 例（61.0%）的婴儿在 26 周，4692 例（69.1%）的婴儿在 27 周。存活率从 2010 年的 136 例（56.4%；95%CI，50.1%-62.7%）增加到 2019 年的 1110 例（68.0%；95%CI，65.7%-70.2%），在 24 至 27 周之间出生的婴儿（平均差异，11.5%；95%CI，4.9%-18.2%；P<.001）有所增加，而胎龄小于 24 周的婴儿则没有明显变化。8281 例婴儿中有 5999 例（72.4%）发生了主要并发症，发病率从 2010 年的 116 例（52.0%；95%CI，45.4%-58.6%）增加到 2019 年的 1363 例（82.3%；95%CI，80.5%-84.1%）（平均差异，30.3%；95%CI，23.5%-37.1%，P<.001）。发现存活率存在区域差异，与中国西北部的 474 例婴儿中的 188 例（39.7%）相比，中国北部的 1153 例婴儿中的 887 例（76.9%）几乎增加了一倍（1.94 倍；95%CI，1.66-2.27；P<.001）。胎龄（调整风险比[aRR]，1.084；95%CI，1.063-1.105；P<.001）、出生体重（aRR，1.028；95%CI，1.020-1.036；P<.001）、胎膜早破（aRR，1.025；95%CI，1.002-1.048；P=.03）和产前类固醇（aRR，1.029；95%CI，1.004-1.055；P=.02）与生存率提高相关，而 SGA 出生（aRR，0.801；95%CI，0.679-0.945；P=.01）、男性（aRR，0.975；95%CI，0.954-0.997；P=.02）、多胎（aRR，0.955；95%CI，0.929-0.982；P=.001）、母亲患有妊娠期糖尿病（aRR，0.946；95%CI，0.913-0.981；P=.002）和低 Apgar 评分（aRR，0.951；95%CI，0.925-0.977；P<.001）是生存率降低的危险因素。
本研究发现，中国极早产儿的死亡率和发病率较高，随着时间的推移，生存率有所提高，主要发病率有所增加。这些发现表明，需要采取更积极有效的治疗策略，特别是对于胎龄在 25 至 27 周之间的婴儿。
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