Tiegs Lyubov, Rholl Erin, McDonnell Siobhan, Paradise Jacquelyn, Uhing Michael, Basir Mir A
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, 999 N 92 St, Milwaukee, WI,USA.
Children's Wisconsin, Milwaukee, Wisconsin, 999 N 92 St, Milwaukee, WI, USA.
Obstet Gynecol Open Access. 2023;7(2). doi: 10.29011/2577-2236.100161. Epub 2023 Jun 9.
Pain and quality of death are important considerations in treatment choices for children. Our objective is to assess the intensive care-associated experiences of 22-25 weeks gestational age (GA) infants who die despite intensive care treatment.
In a 1:1 case-control study, medical records were screened for all inborn 22-25 weeks GA infants who received intensive care treatments between 2014 and 2020. Cases were all infants who died. Each case was matched by GA and birth weight to an infant who survived to discharge (control). Data was collected on cases and controls for a matched timeframe based on the case's duration of intensive care treatment. Information collected included intensive care-associated negative experiences (invasive procedures, surgeries, use of pain medication) and positive experiences (enteral feedings, being held by family).
The cases (n=20) survived for 0 to 93 days, with median (IQR) survival 8 (5, 24) days. The mean (SD) number of invasive procedures was higher for cases than controls, 34 (30) vs. 24 (22), p=0.004. Cases underwent 8 surgeries compared to 4 in the controls. Additionally, compared to controls, cases spent more time receiving pain medications (64% vs. 27%, p<0.001) and without being fed (54% vs. 39%, p<0.001). Half of cases were never held by parents until the day they died.
Extremely premature infants who die despite intensive care face more treatment burdens than the survivors. Larger studies are needed to confirm these findings and gather information necessary for informed decisions about intensive care treatment of these infants.
疼痛和死亡质量是儿童治疗选择中的重要考量因素。我们的目的是评估尽管接受了重症监护治疗但仍死亡的孕22 - 25周胎龄（GA）婴儿的重症监护相关经历。
在一项1:1病例对照研究中，对2014年至2020年间接受重症监护治疗的所有孕22 - 25周GA的出生婴儿的病历进行筛查。病例为所有死亡婴儿。每个病例根据GA和出生体重与一名存活至出院的婴儿（对照）进行匹配。根据病例的重症监护治疗时长，在匹配的时间范围内收集病例和对照的数据。收集的信息包括重症监护相关的负面经历（侵入性操作、手术、使用止痛药物）和正面经历（肠内喂养、被家人抱）。
病例组（n = 20）存活0至93天，中位（IQR）生存期为8（5，24）天。病例组的侵入性操作平均（SD）次数高于对照组，分别为34（30）次和24（22）次，p = 0.004。病例组进行了8次手术，而对照组为4次。此外，与对照组相比，病例组接受止痛药物的时间更长（64%对27%，p < 0.001），未接受喂养的时间也更长（54%对39%，p < 0.001）。一半的病例直到死亡当天都从未被父母抱过。
尽管接受了重症监护治疗但仍死亡的极早产儿面临的治疗负担比存活者更多。需要更大规模的研究来证实这些发现，并收集有关这些婴儿重症监护治疗的明智决策所需的信息。
