Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China.
Department of Paediatrics, Jinan Maternal and Child Health Hospital, Jinan, China.
J Glob Health. 2023 May 26;13:04059. doi: 10.7189/jogh.13.04059.
Published guidelines on decision-making and resuscitation of extremely preterm infants primarily focus on high-income countries. For rapidly industrializing ones like China, there is a lack of population-based data for informing prenatal management and practice guidelines.
The Sino-northern Neonatal Network conducted a prospective multi-centre cohort study between 1 January 2018 and 31 December 2021. Infants with a gestational age (GA) between 22 (postnatal age in days = 0) and 28 (postnatal age in days = 6) admitted to 40 tertiary NICUs in northern China were included and evaluated for death or severe neurological injury before discharge.
For all extremely preterm infants (n = 5838), the proportion of admission to the neonatal was 4.1% at 22-24 weeks, 27.2% at 25-26 weeks, and 75.2% at 27 and 28 weeks. Among 2228 infants admitted to the NICU, 216 (11.1%) were still elected for withdrawal of care (WIC) due to non-medical factors. Survival rates without severe neurological injury were 6.7% for infants at 22-23 weeks, 28.0% at 24 weeks, 56.7% at 24 weeks, 61.7% at 25 weeks, 79.9% at 26 weeks, and 84.5% at 27 and 28 weeks. Compared with traditional criterion at 28 weeks, the relative risk for death or severe neurological injury were 1.53 (95% confidence interval (CI) = 1.26-1.86) at 27 weeks, 2.32 (95% CI = 1.73-3.11) at 26 weeks, 3.62 (95% CI = 2.43-5.40) at 25 weeks, and 8.91 (95% CI = 4.69-16.96) at 24 weeks. The NICUs with higher proportion of WIC also had a higher rate of death or severe neurological injury after maximal intensive care (MIC).
Compared to the traditional threshold of 28 weeks, more infants received MIC after 25 weeks, leading to significant increases in survival rates without severe neurological injury. Therefore, the resuscitation threshold should be gradually adjusted from 28 to 25 weeks based on reliable capacity.
China Clinical Trials Registry. ID: ChiCTR1900025234.
已发表的关于极早产儿决策和复苏的指南主要集中在高收入国家。对于像中国这样快速工业化的国家，缺乏基于人群的数据来为产前管理和实践指南提供信息。
中国北方新生儿网络于 2018 年 1 月 1 日至 2021 年 12 月 31 日进行了一项前瞻性多中心队列研究。纳入中国北方 40 家三级新生儿重症监护病房（NICU）收治的胎龄为 22（出生后天数=0）至 28 周（出生后天数=6）的早产儿，并在出院前评估其死亡或严重神经损伤的情况。
对于所有极早产儿（n=5838），22-24 周时新生儿入院比例为 4.1%，25-26 周时为 27.2%，27 和 28 周时为 75.2%。在 2228 名被收入 NICU 的婴儿中，有 216 名（11.1%）因非医疗因素而选择放弃治疗（WIC）。22-23 周时无严重神经损伤的生存率为 6.7%，24 周时为 28.0%，24 周时为 56.7%，25 周时为 61.7%，26 周时为 79.9%，27 和 28 周时为 84.5%。与 28 周时的传统标准相比，27 周时死亡或严重神经损伤的相对风险为 1.53（95%置信区间[CI]为 1.26-1.86），26 周时为 2.32（95%CI 为 1.73-3.11），25 周时为 3.62（95%CI 为 2.43-5.40），24 周时为 8.91（95%CI 为 4.69-16.96）。WIC 比例较高的 NICU 在接受最大程度的强化治疗（MIC）后，死亡率或严重神经损伤的发生率也较高。
与 28 周的传统阈值相比，更多的婴儿在 25 周后接受了 MIC，导致无严重神经损伤的生存率显著提高。因此，复苏阈值应根据可靠的能力，从 28 周逐渐调整至 25 周。
中国临床试验注册中心。注册号：ChiCTR1900025234。
