Hwang Ji Hye, Jung Euiseok, Lee Byong Sop, Kim Ellen Ai Rhan, Kim Ki Soo
Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2021 Aug 9;36(31):e206. doi: 10.3346/jkms.2021.36.e206.
This study aimed to investigate the survival and morbidities of infants in the Korean Neonatal Network (KNN) with birth weight (BW) < 500 g.
The demographic and clinical data of 208 live-born infants with a BW < 500 g at a gestational age of ≥ 22 weeks who were treated in the neonatal intensive care units of the KNN between 2013 and 2017 were reviewed.
The survival rate of the infants was 28%, with a median gestational age and BW of 24 weeks (range, 22-33) and 440 g (range, 220-499), respectively. Multivariable Cox proportional hazards analysis demonstrated that survival to discharge was associated with longer gestation, higher BW, female sex, singleton gestation, use of any antenatal corticosteroids, and higher Apgar scores at 5 minutes. The overall survival rates were significantly different between the BW categories of < 400 g and 400-499 g. However, there was no significant difference in the incidence of any morbidity between the BW groups. Half of the deaths of infants with BW < 500 g occurred within a week of life, mainly due to cardiopulmonary and neurologic causes. The major causes of death in infants after 1 week of age were infection and gastrointestinal disease. Among the surviving infants, 79% had moderate to severe bronchopulmonary dysplasia, 21% underwent surgical ligation of patent ductus arteriosus, 12% had severe intraventricular hemorrhage (grade III-IV), 38% had sepsis, 9% had necrotizing enterocolitis (stage ≥ 2), and 47% underwent laser treatment for retinopathy of prematurity. The median length of hospital stay was 132 days (range, 69-291), and 53% required assistive devices at discharge.
Despite recent advances in neonatal intensive care, the survival and morbidity rates of infants with BW < 500 g need further improvement.
本研究旨在调查韩国新生儿网络（KNN）中出生体重（BW）<500g的婴儿的生存率和发病率。
回顾了2013年至2017年期间在KNN的新生儿重症监护病房接受治疗的208例胎龄≥22周、出生体重<500g的活产婴儿的人口统计学和临床数据。
婴儿的生存率为28%，中位胎龄和出生体重分别为24周（范围22 - 33周）和440g（范围220 - 499g）。多变量Cox比例风险分析表明，出院存活率与孕周延长、出生体重增加、女性、单胎妊娠、使用任何产前皮质类固醇以及5分钟时较高的阿氏评分相关。出生体重<400g和400 - 499g的类别之间总体存活率有显著差异。然而，出生体重组之间任何发病率的发生率没有显著差异。出生体重<500g的婴儿中有一半在出生后一周内死亡，主要原因是心肺和神经原因。1周龄后婴儿死亡的主要原因是感染和胃肠道疾病。在存活的婴儿中，79%患有中度至重度支气管肺发育不良，21%接受了动脉导管未闭手术结扎，12%患有严重脑室内出血（III - IV级），38%患有败血症，9%患有坏死性小肠结肠炎（≥2期），47%接受了早产儿视网膜病变激光治疗。中位住院时间为132天（范围69 - 291天），53%在出院时需要辅助设备。
尽管新生儿重症监护最近取得了进展，但出生体重<500g的婴儿的生存率和发病率仍需进一步提高。
