Neonatal Intensive Care Unit, Golisano Children's Hospital of Southwest Florida, Florida.
University of Florida College of Medicine, Jacksonville, Florida.
Am J Perinatol. 2024 May;41(S 01):e94-e102. doi: 10.1055/a-1845-2526. Epub 2022 May 6.
Data from the academic medical centers in the United States showing improvements in survival of periviable infants born at 22 to 24 weeks GA may not be nationally representative since a substantial proportion of preterm infants are cared for in community hospital-based neonatal intensive care units. Our objective was to examine the national trends in survival and other short-term outcomes among preterm infants born at ≤24 weeks gestational age (GA) in the United States from 2009 to 2018.
This was a retrospective, repeated cross-sectional analysis of the National Inpatient Sample for preterm infants ≤24 weeks GA. The primary outcome was the trends in survival to discharge. Secondary outcomes were the trends in the composite outcome of death or one or more major morbidity (bronchopulmonary dysplasia, necrotizing enterocolitis stage ≥2, periventricular leukomalacia, severe intraventricular hemorrhage, and severe retinopathy of prematurity). The Cochran-Armitage trend test was used for trend analysis. -Value <0.05 was considered significant.
Among 71,854 infants born at ≤24 weeks GA, 34,251 (47.6%) survived less than 1 day and were excluded. Almost 93% of those who survived <1 day were of ≤23 weeks GA. Among the 37,603 infants included in the study cohort, 48.1% were born at 24 weeks GA. Survival to discharge at GA ≤ 23 weeks increased from 29.6% in 2009 to 41.7% in 2018 ( < 0.001), while survival to discharge at GA 24 weeks increased from 58.3 to 65.9% ( < 0.001). There was a significant decline in the secondary outcomes among all the periviable infants who survived ≥1 day of life.
Survival to discharge among preterm infants ≤24 weeks GA significantly increased, while death or major morbidities significantly decreased from 2009 to 2018. The postdischarge survival, health care resource use, and long neurodevelopmental outcomes of these infants need further investigation.
· Survival increased significantly in infants ≤24 weeks GA in the United States from 2009 to 2018.. · Death or major morbidity in infants ≤24 weeks GA decreased significantly from 2009 to 2018.. · Death or surgical procedures including tracheostomy, VP shunt placement, and PDA surgical closure in infants <=24 weeks GA decreased significantly from 2009 to 2018..
美国学术医学中心的数据显示，22 至 24 周胎龄的极早产儿的生存率有所提高，但这些数据可能不具有全国代表性，因为大量早产儿在社区医院的新生儿重症监护病房接受治疗。我们的目的是研究 2009 年至 2018 年期间美国≤24 周胎龄早产儿的生存率和其他短期结局的全国趋势。
这是一项对≤24 周胎龄早产儿的国家住院患者样本进行的回顾性、重复横断面分析。主要结局是出院生存率的趋势。次要结局是死亡或一种或多种主要并发症（支气管肺发育不良、坏死性小肠结肠炎 2 期及以上、脑室周围白质软化、严重颅内出血和早产儿视网膜病变）复合结局的趋势。采用 Cochran-Armitage 趋势检验进行趋势分析。P 值<0.05 被认为具有统计学意义。
在 71854 名≤24 周胎龄的婴儿中，有 34251 名（47.6%）存活不到 1 天，被排除在外。存活不到 1 天的婴儿中，几乎 93%的胎龄小于 23 周。在纳入研究队列的 37603 名婴儿中，有 48.1%的胎龄为 24 周。胎龄≤23 周的早产儿出院生存率从 2009 年的 29.6%增加到 2018 年的 41.7%（P<0.001），而胎龄为 24 周的早产儿出院生存率从 58.3%增加到 65.9%（P<0.001）。所有存活≥1 天的极早产儿的次要结局均显著下降。
2009 年至 2018 年，≤24 周胎龄早产儿的出院生存率显著提高，而死亡或主要并发症显著减少。这些婴儿的出院后生存、医疗资源利用和长期神经发育结局需要进一步研究。
