Neonatal Follow-up Program, King Edward Memorial Hospital, United States of America; Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Perth, Western Australia, Australia; Neonatal and Life Course Health Program Team, Telethon Kids Institute, Perth, Western Australia, Australia.
Neonatal Follow-up Program, King Edward Memorial Hospital, United States of America; Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Perth, Western Australia, Australia. Electronic address: mei'
Early Hum Dev. 2022 Apr;167:105553. doi: 10.1016/j.earlhumdev.2022.105553. Epub 2022 Feb 22.
Extremely preterm (EP) infant survival has significantly improved with advanced neonatal care; however outcomes of infants born with birth weight (BW) ≤500 g remain poor. We aimed to review outcomes of this cohort in our institution.
Retrospective study of all inborn preterm infants born at ≥22 weeks gestational age (GA) and weighing ≤500 g between January 2001-December 2017. Outcomes included short-term morbidity, mortality, neurodevelopmental impairment and growth up to five years of age.
Of a total 438 eligible infants, 92 livebirths were admitted to intensive care [median (range) GA: 24 (22-30) weeks; median (IQR) BW: 427.5 (380-499) grams]. Majority [78/92 (84.7%)] were small for gestational age (SGA). In 50% of non-survivors, median (IQR) age of death was 3.5 (1-17.5) days with no late deaths. Medical morbidities were common. Follow-up, including standardised cognitive assessments, was available for 41/46 (89%) infants. At a median age of 5.06 years, 17/41 (41.5%) had moderate-severe disability; non-statistically higher in SGA compared to appropriate for gestational age/AGA (48.6% vs. 33.3%) group. Cerebral palsy (4/41; 10%), deafness needing amplification (1/41; 2.4%) were noted. Weight (32/41, 78%) and height (27/41, 66%) of most children remained at >2 SD below normal.
In a cohort of preterm infants weighing ≤500 g at birth, 50% survived after admission to intensive care. Medical morbidities were common and 54% were free from moderate to severe disability at five years. SGA infants had higher rates (48.6%) of moderate to severe disability. Ongoing suboptimal growth in childhood is common.
随着新生儿护理技术的进步，极早产儿（extremely preterm，EP）的存活率显著提高；然而，出生体重（birth weight，BW）≤500g 的婴儿的预后仍然较差。本研究旨在回顾本机构中这部分患者的结局。
对 2001 年 1 月至 2017 年 12 月期间胎龄≥22 周且 BW≤500g 的所有极早早产儿进行回顾性研究。结局包括短期发病率、死亡率、神经发育损伤以及 5 岁时的生长情况。
在符合条件的 438 名婴儿中，有 92 例活产儿入住重症监护病房[中位（范围）胎龄：24（22-30）周；中位（IQR）BW：427.5（380-499）g]。大多数[78/92（84.7%）]为小于胎龄儿（small for gestational age，SGA）。在 50%的死亡患儿中，死亡时的中位（IQR）年龄为 3.5（1-17.5）天，无晚期死亡。常见的医疗并发症。46 例（89%）患儿中有 41 例接受了随访，包括标准化认知评估。在中位年龄为 5.06 岁时，17 例（41.5%）患儿存在中重度残疾；SGA 患儿的残疾发生率（48.6%）高于适于胎龄/AGA（appropriate for gestational age/AGA）患儿（33.3%），但差异无统计学意义。41 例患儿中有 4 例（10%）患有脑瘫，1 例（2.4%）患有需要助听器的耳聋。大多数患儿的体重（32/41，78%）和身高（27/41，66%）仍低于正常水平 2 个标准差以上。
在 BW≤500g 的早产儿中，50%的患儿在入住重症监护病房后存活。常见的医疗并发症，5 岁时 54%的患儿无中重度残疾。SGA 患儿的中重度残疾发生率（48.6%）更高。儿童期持续的生长发育不良较为常见。
