Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, Michigan.
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Texas-Houston, Houston, Texas.
Am J Perinatol. 2024 May;41(S 01):e2985-e2989. doi: 10.1055/a-2184-1374. Epub 2023 Sep 29.
This study aimed to investigate whether neonatal morbidity differs in spontaneous compared with indicated preterm births in extremely premature neonates.
This is a retrospective cohort study including births ≤28 weeks at a single institution from 2011 to 2020. Births were categorized as either medically indicated or spontaneous preterm deliveries. The primary outcome was inhospital mortality and serious morbidity in survivors. -tests, Fisher's exact tests, chi-square tests, and logistic regression models were utilized as appropriate. < 0.05 was significant.
Two hundred and twenty-seven births were included, with two-thirds representing spontaneous births (65.6%, 149/227) and one-third categorized as medically indicated births (34.4%, 78/227). Inhospital mortality was more common in the spontaneous preterm birth group ( = 0.04), while inhospital morbidity did not significantly vary between the medically indicated and spontaneous birth groups ( = 0.32). There was no difference in inhospital morbidity or mortality by maternal race. In multivariate models of inhospital morbidity and mortality, gestational age was the only significant predictor of adverse outcomes.
Despite inhospital mortality being more common in spontaneous preterm births, inhospital mortality and significant morbidity are best accounted for by gestational age alone.
· Inhospital death is more common in spontaneous preterm births.. · Perinatal outcomes do not differ on the basis of racial/ethnic group.. · Gestational age is the best predictor of inhospital morbidity and mortality..
本研究旨在探讨自发性早产与医学指征性早产相比，在极早产儿中是否存在不同的新生儿发病率。
这是一项回顾性队列研究，纳入了 2011 年至 2020 年在单家机构出生且胎龄≤28 周的婴儿。将分娩分为自发性早产和医学指征性早产。主要结局为住院期间的死亡率和幸存者的严重发病率。使用 t 检验、Fisher 确切检验、卡方检验和逻辑回归模型进行适当分析。 < 0.05 为差异有统计学意义。
共纳入 227 例分娩，其中三分之二为自发性早产（65.6%，149/227），三分之一为医学指征性早产（34.4%，78/227）。自发性早产组的住院死亡率更高（ = 0.04），而医学指征性早产组与自发性早产组的住院发病率差异无统计学意义（ = 0.32）。产妇种族之间的住院发病率或死亡率没有差异。在住院发病率和死亡率的多变量模型中，胎龄是不良结局的唯一显著预测因素。
尽管自发性早产的住院死亡率更高，但住院死亡率和严重发病率仅由胎龄单独决定。
· 自发性早产的住院死亡更常见。
· 围产儿结局不因种族/民族群体而异。
· 胎龄是住院发病率和死亡率的最佳预测因素。
