2004-2007 年、2014-2016 年和 2017-2019 年瑞典 22 至 23 孕周出生婴儿的一年生存率和结局。

One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019.

机构信息

Department of Clinical Sciences, Pediatrics, Umeå University, Umea, Sweden

Department of Clinical Sciences, Pediatrics, Umeå University, Umea, Sweden.

出版信息

Arch Dis Child Fetal Neonatal Ed. 2023 Dec 15;109(1):10-17. doi: 10.1136/archdischild-2022-325164.

DOI:10.1136/archdischild-2022-325164

PMID:37290903

Abstract

OBJECTIVE

To explore associations between perinatal activity and survival in infants born at 22 and 23 weeks of gestation in Sweden.

DESIGN/SETTING: Data on all births at 22 and 23 weeks' gestational age (GA) were prospectively collected in 2004-2007 (T1) or obtained from national registers in 2014-2016 (T2) and 2017-2019 (T3). Infants were assigned perinatal activity scores based on 3 key obstetric and 4 neonatal interventions.

MAIN OUTCOME

One-year survival and survival without major neonatal morbidities (MNM): intraventricular haemorrhage grade 3-4, cystic periventricular leucomalacia, surgical necrotising enterocolitis, retinopathy of prematurity stage 3-5 or severe bronchopulmonary dysplasia. The association of GA-specific perinatal activity score and 1-year survival was also determined.

RESULTS

977 infants (567 live births and 410 stillbirths) were included: 323 born in T1, 347 in T2 and 307 in T3. Among live-born infants, survival at 22 weeks was 5/49 (10%) in T1 and rose significantly to 29/74 (39%) in T2 and 31/80 (39%) in T3. Survival was not significantly different between epochs at 23 weeks (53%, 61% and 67%). Among survivors, the proportions without MNM in T1, T2 and T3 were 20%, 17% and 19% for 22 weeks and 17%, 25% and 25% for 23 weeks' infants (p>0.05 for all comparisons). Each 5-point increment in GA-specific perinatal activity score increased the odds for survival in first 12 hours of life (adjusted OR (aOR) 1.4; 95% CI 1.3 to 1.6) in addition to 1-year survival (aOR 1.2; 95% CI 1.1 to 1.3), and among live-born infants it was associated with increased survival without MNM (aOR 1.3; 95% CI 1.1 to 1.4).

CONCLUSION

Increased perinatal activity was associated with reduced mortality and increased chances of survival without MNM in infants born at 22 and 23 weeks of GA.

摘要

目的

探索在瑞典，22 至 23 孕周出生的婴儿围产期活动与生存之间的关联。

设计/设置：2004 年至 2007 年（T1 期）前瞻性收集了所有 22 及 23 孕周出生婴儿的数据，或从 2014 年至 2016 年（T2 期）和 2017 年至 2019 年（T3 期）国家登记处获得数据。根据 3 项关键产科和 4 项新生儿干预措施，对婴儿进行围产期活动评分。

主要结果

1 年生存率和无主要新生儿并发症（MNM）生存率：脑室出血 3-4 级、囊性脑室周围白质软化、手术性坏死性小肠结肠炎、早产儿视网膜病变 3-5 期或严重支气管肺发育不良。还确定了特定 GA 的围产期活动评分与 1 年生存率之间的关系。

结果

共纳入 977 名婴儿（567 例活产和 410 例死产）：323 例出生于 T1 期，347 例出生于 T2 期，307 例出生于 T3 期。在 22 孕周出生的活产婴儿中，T1 期的生存率为 5/49（10%），T2 期显著上升至 29/74（39%），T3 期为 31/80（39%）。23 孕周时各时期的生存率无显著差异（53%、61%和 67%）。在幸存者中，T1、T2 和 T3 期 22 孕周婴儿无 MNM 的比例分别为 20%、17%和 19%，23 孕周婴儿的比例分别为 17%、25%和 25%（所有比较均 P>0.05）。特定 GA 的围产期活动评分每增加 5 分，可增加 12 小时内存活的几率（校正比值比（aOR）1.4；95%CI 1.3 至 1.6），以及 1 年生存率（aOR 1.2；95%CI 1.1 至 1.3），在活产婴儿中，与无 MNM 生存率的增加相关（aOR 1.3；95%CI 1.1 至 1.4）。