Al Hazzani Fahad, Al Alaiyan Saleh, Jabr Mohammed Bin, Binmanee Abdulaziz, Shaltout Mahmoud, Al Motairy Yazeed Moqbil, Qashqary Abdulhameed Sami, Al Dughaither Abdullah Saleh
Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Saudi Arabia.
Int J Pediatr Adolesc Med. 2021 Jun;8(2):98-101. doi: 10.1016/j.ijpam.2020.03.008. Epub 2020 Jun 4.
Initiation or withholding life support at birth on infants born prematurely near the limit of viability is not an easy decision, with wide variation in practice around the world. Our aim was to review the outcome of preterm infants born near the limit of viability at 23-25 weeks gestation in our institution, with regard to resuscitation decision, survival, and major outcome measures.
We included all live newborn infants born prematurely at 23-25 weeks gestation at King Faisal Specialist Hospital and Research Centre from January 2006 to December 2015. We collected data on resuscitation decisions, survival, and major neonatal morbidities such as severe brain injury, severe retinopathy of prematurity, and bronchopulmonary dysplasia.
Between January 1, 2006 and December 31, 2015, 97 infants with a gestational age (GA) of 23-25 weeks gestation were admitted; 23, 42, and 32 infants were born at 23, 24, and 25 weeks gestation, respectively. At 23 weeks gestation, full support was initiated in 87% of patients and later on support was withheld in 17.4% of patients, finally 13% of patients survived to discharge. At 24 weeks, full support was initiated in 97.6% of patients, then withheld in 7.1% of patients, and ultimately 59.5% survived. At 25 weeks, full support was initiated in 93.8% of patients, then withheld in 15.6% of patients, and ultimately 62.5% survived. In terms of survival with and without the three major neonatal morbidities, at 23 weeks gestation, no infant survived without any morbidity as compared to 7.1% and 28.1% at 24 and 25 weeks, respectively. The incidence of survival with 1 major morbidity was 8.7%, 30.9%, and 34.4% at 23, 24, and 25 weeks, respectively, the incidence of survival with 2 major morbidities was 0%, 19%, and 0% at 23, 24, and 25 weeks, respectively, and the incidence of survival with 3 major morbidities was 4.3%, 2.4%, and 0% at 23, 24, and 25 weeks, respectively.
In our patient cohort, survival and survival without major neonatal morbidity were very low at 23 weeks gestation, but it improved gradually as gestational age advanced.
对于出生时接近可存活极限的早产儿，决定在出生时启动或停止生命支持并非易事，世界各地的实践差异很大。我们的目的是回顾在我们机构中孕23 - 25周出生、接近可存活极限的早产儿在复苏决策、生存及主要结局指标方面的情况。
我们纳入了2006年1月至2015年12月在费萨尔国王专科医院和研究中心孕23 - 25周早产的所有活产新生儿。我们收集了关于复苏决策、生存以及严重脑损伤、严重早产儿视网膜病变和支气管肺发育不良等主要新生儿疾病的数据。
在2006年1月1日至2015年12月31日期间，收治了97例孕龄（GA）为23 - 25周的婴儿；分别有23例、42例和32例婴儿在孕23周、24周和25周出生。在孕23周时，87%的患者开始接受全面支持，后来17.4%的患者停止支持，最终13%的患者存活至出院。在孕24周时，97.6%的患者开始接受全面支持，随后7.1%的患者停止支持，最终59.5%的患者存活。在孕25周时，93.8%的患者开始接受全面支持，随后15.6%的患者停止支持，最终62.5%的患者存活。在有或无三种主要新生儿疾病的情况下，在孕23周时，没有婴儿在无任何疾病的情况下存活，而在孕24周和25周时这一比例分别为7.1%和28.1%。孕23周、24周和25周时，有1种主要疾病存活的发生率分别为8.7%、30.9%和34.4%；孕23周、24周和25周时，有2种主要疾病存活的发生率分别为0%、19%和0%；孕23周、24周和25周时，有3种主要疾病存活的发生率分别为4.3%、2.4%和0%。
在我们的患者队列中，孕23周时的存活率及无主要新生儿疾病的存活率很低，但随着孕周增加逐渐改善。
