Alabdullatif Mustafa, Butt Fahad, BenAyad Aimen, Rahmani Aiman
Neonatology, Tawam Hospital, Al Ain, ARE.
Pediatrics and Neonatology, Tawam Hospital, Al Ain, ARE.
Cureus. 2024 Nov 17;16(11):e73877. doi: 10.7759/cureus.73877. eCollection 2024 Nov.
The limit of periviability is constantly changing as infants born at 22-25 weeks of gestation increasingly survive. The data from our region are limited due to the small numbers of these infants among the NICU population. In this study, we evaluated the survival rates and short-term outcomes among preterm neonates between 22 and 24 weeks of gestation admitted to Tawam Hospital, United Arab Emirates. Our retrospective analysis included 100 cohorts of newborns from 22 to 25 weeks of gestation throughout the eight-year period in our level 3 NICU. We evaluated the use and effects of prenatal steroids and intrapartum antibiotics, in addition to perinatal complications, and examined their outcomes (survival, length of stay, and major morbidities). The survival rate of our periviable neonates was 18% (N = 18/100). Only one 22-week infant out of 32 cases (3%) survived during the study period in 2023. In contrast, the survival rate of infants of 23- and 24-week gestational age was 10% (N = 4/40) and 46% (N = 13/28), respectively. Although our focus in this study was to evaluate the survival of neonates who were born at around the limits of viability, we also reported the short-term outcomes at our single center, including intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC). Our data demonstrate that the trend of increasing survival with higher gestational age continues to improve over time. However, there was a significant risk of short-term co-morbidities for those who survived. Further studies are required to have robust data on short and long-term outcomes for this population. The information provided by this study could be essential for counseling parents, enabling them to participate actively in formulating their infants' care plans. It may also help parents and healthcare professionals reach a more informed and collaborative decision regarding active resuscitation and subsequent care plans for these periviable neonates.
随着孕22 - 25周出生的婴儿存活率不断提高，围产儿存活极限也在持续变化。由于新生儿重症监护病房（NICU）中这类婴儿数量较少，我们所在地区的数据有限。在本研究中，我们评估了入住阿联酋塔瓦姆医院的孕22至24周早产新生儿的存活率和短期预后。我们的回顾性分析纳入了8年间在我们三级NICU中100例孕22至25周的新生儿队列。除了围产期并发症外，我们评估了产前类固醇和产时抗生素的使用及效果，并检查了他们的预后（存活、住院时间和主要疾病）。我们的围产儿存活新生儿的存活率为18%（N = 18/100）。在2023年的研究期间，32例22周婴儿中只有1例（3%）存活。相比之下，孕23周和24周婴儿的存活率分别为10%（N = 4/40）和46%（N = 13/28）。尽管本研究的重点是评估出生在存活极限附近的新生儿的存活率，但我们也报告了我们单中心的短期预后，包括脑室内出血（IVH）、脑室周围白质软化（PVL）、支气管肺发育不良（BPD）、早产儿视网膜病变（ROP）和坏死性小肠结肠炎（NEC）。我们的数据表明，随着胎龄增加存活率上升的趋势随着时间的推移持续改善。然而，对于存活者来说，存在短期合并症的重大风险。需要进一步研究以获得关于该人群短期和长期预后的可靠数据。本研究提供的信息对于为家长提供咨询至关重要，使他们能够积极参与制定婴儿的护理计划。这也可能有助于家长和医护人员就是否对这些围产儿进行积极复苏及后续护理计划做出更明智和协作性的决定。
