Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkville, Victoria, Australia
Mercy Hospital for Women, Heidelberg, Victoria, Australia.
BMJ Paediatr Open. 2024 Oct 21;8(1):e002462. doi: 10.1136/bmjpo-2023-002462.
Care for infants born at 22-24 weeks' gestation varies globally, with an increasing willingness to provide survival-focused ('active') care for infants born at 22 weeks' gestation in recent years. This study aims to report changes in care for infants born at 22-24 weeks before and after the introduction of a statewide guideline for extreme prematurity (EP).
A retrospective cohort study was conducted, including all live births at 22-24 weeks in tertiary perinatal centres from 1 January 2015 to 31 December 2022 in Victoria, Australia. Medical records were reviewed to obtain antenatal history and perinatal outcomes. Data on in utero referral and transfer to tertiary perinatal centres were sourced from the statewide perinatal emergency retrieval service (Paediatric Infant Perinatal Emergency Retrieval, PIPER) database. Changes in PIPER referrals and transfers, survival-focused care and survival at 28 days preguideline and postguideline were assessed using logistic regression.
Following the guideline, at 22 weeks' gestation, there was an increase in referrals to PIPER and a 3.31 (95% CI 1.84 to 5.95) higher likelihood of in utero transfer to tertiary centres.Following the guideline, infants had a 6.67 (95% CI 1.40 to 31.72) higher likelihood of receiving survival-focused care at 22 weeks, and a 5.57 (95% CI 1.22 to 25.44) higher likelihood at 23 weeks. All 24-week live births received survival-focused care at birth. The 28-day survival for infants who received survival-focused care was unchanged preguideline and postguideline.
Following the publication of the EP guideline in Victoria, in utero referrals and transfers at 22 weeks' gestation have increased, as has survival-focused management of inborn live births at 22-24 weeks.
全球范围内，22-24 孕周出生婴儿的护理方式各不相同，近年来，人们越来越愿意为 22 孕周出生的婴儿提供以生存为重点的（“积极”）护理。本研究旨在报告在维多利亚州发布极端早产儿（EP）全州指南前后，22-24 孕周出生婴儿的护理方式的变化。
本研究是一项回顾性队列研究，纳入了 2015 年 1 月 1 日至 2022 年 12 月 31 日期间澳大利亚维多利亚州三级围产中心出生的所有 22-24 孕周活产儿。查阅病历以获取产前病史和围产儿结局。宫内转诊和转运至三级围产中心的数据来自全州围产急救服务（儿科婴儿围产急救检索，PIPER）数据库。使用逻辑回归评估指南发布前后 PIPER 转诊和转运、以生存为重点的护理以及 28 天预指南和后指南的生存率的变化。
在指南发布后，22 孕周时 PIPER 转诊增加，宫内转运至三级中心的可能性增加 3.31 倍（95%CI 1.84 至 5.95）。在指南发布后，22 孕周时接受以生存为重点的护理的可能性增加了 6.67 倍（95%CI 1.40 至 31.72），23 孕周时增加了 5.57 倍（95%CI 1.22 至 25.44）。所有 24 孕周的活产儿在出生时均接受了以生存为重点的护理。接受以生存为重点的护理的婴儿 28 天生存率在指南发布前后无变化。
在维多利亚州发布 EP 指南后，22 孕周时宫内转诊和转运增加，22-24 孕周出生的活产儿以生存为重点的管理也增加。
