Holmsgaard K W, Petersen S
Department of Neonatology, Juliane Marie Center for Women, Children and Reproduction, The National University Hospital (Rigshospitalet), Copenhagen.
Dan Med Bull. 1996 Feb;43(1):86-91.
The objective of the study was to evaluate neonatal survival and subsequent disabilities in infants with extremely low gestational age in relation to perinatal events and neonatal treatment. A retrospective follow-up study was performed based on medical records, questionnaires to parents and recordings of contact with health authorities. All infants with a gestational age 28 completed weeks or less, who were admitted to the Department of Neonatology, Rigshospitalet, within 24 hours of age during the period January 1, 1987 - December 31, 1990 were included. During this period the basic therapeutic approach was a combination of minimal handling and early nasal-continuous positive airway pressure (CPAP) ("minitouch"). Main outcome measures were: mortality, healthy survival and disabled survival. Variables related to outcome were: risk factors present at birth (gestational age, birth weight, gender, place of birth (Rigshospitalet/other hospital), mode of delivery, Apgar score at five minutes; interventions in the neonatal period (intermittent positive pressure ventilation and treatment of hypotension); complications in the neonatal period (intracranial haemorrhage grade II-IV, periventricular leucomalacia, pneumothorax, seizures and septicaemia). One hundred and ninety-seven infants without major malformations were included. The mortality rate was 29%. Among infants with gestational age 24-25 weeks 49% died versus 24% of infants born after 26-28 weeks (p = 0.004). Mean gestational age was 26.7 weeks (range 24-28) and mean birth weight 994 g (range 525-1630). Fifty-five infants (28%) were small-for-gestational age. One hundred and fifty-five infants (79%) were born in our hospital and 115 (58%) were delivered by caesarean section. A total of 140 infants (71%) survived until discharge and none died between discharge and follow-up. At follow-up at a mean uncorrected age of 48 months information was obtained about all infants, except two (1%) who had emigrated; 75 (54%) had no impairments, 31 (22%) had minor impairments, 17 (12%) were moderately disabled, and 15 (11%) were severely disabled. Of the 197 infants 121 (61%) were treated with intermittent positive pressure ventilation, 83 (42%) with dopamine for hypotension, and 92 (47%) received parenteral nutrition. In 64 infants (33%) the course was complicated with intracranial haemorrhage (ICH) grade II-IV, in 17 (9%) with seizures, in 23 (12%) with pneumothorax, in 21 (11%) with septicaemia, and in 10 (5%) with necrotizing enterocolitis. Sixty infants (31%) needed medical or surgical closure of a persistent ductus arteriosus. In 11 infants (6%) cystic periventricular leucomalacia occurred, 10 infants (5%) developed retinopathy of prematurity stage 3-4, and 35 infants (24%) received supplementary oxygen at 28 days of age. Risk factors present at birth for adverse outcome were: Apgar score <7 at five minutes, birth weight <1000 g, male sex and birth in another hospital than Rigshospitalet, For adverse outcome in surviving infants only, ICH grade II-IV was the only significant risk factor.
本研究的目的是评估孕周极短的婴儿的新生儿存活率及随后的残疾情况，并分析其与围产期事件和新生儿治疗的关系。基于病历、对家长的问卷调查以及与卫生当局的联系记录进行了一项回顾性随访研究。纳入了所有在1987年1月1日至1990年12月31日期间，出生24小时内被收入哥本哈根大学医院新生儿科、孕周28足周及以下的婴儿。在此期间，基本治疗方法是最小化护理与早期经鼻持续气道正压通气（CPAP）（“轻触”）相结合。主要结局指标为：死亡率、健康存活和残疾存活。与结局相关的变量包括：出生时存在的危险因素（孕周、出生体重、性别、出生地点（哥本哈根大学医院/其他医院）、分娩方式、5分钟Apgar评分）；新生儿期的干预措施（间歇正压通气和低血压治疗）；新生儿期并发症（II-IV级颅内出血、脑室周围白质软化、气胸、惊厥和败血症）。纳入了197例无严重畸形的婴儿。死亡率为29%。孕周24-25周的婴儿中49%死亡，而孕周26-28周后出生的婴儿中这一比例为24%（p = 0.004）。平均孕周为26.7周（范围24-28周），平均出生体重994 g（范围525-1630 g）。55例婴儿（28%）为小于胎龄儿。155例婴儿（79%）在我院出生，115例（58%）通过剖宫产分娩。共有140例婴儿（71%）存活至出院，出院后至随访期间无死亡。在平均未矫正年龄48个月进行随访时，除2例（1%）移民的婴儿外，获取了所有婴儿的信息；75例（54%）无损伤，31例（22%）有轻度损伤，17例（12%）中度残疾，15例（11%）重度残疾。197例婴儿中，121例（61%）接受了间歇正压通气治疗，83例（42%）因低血压接受多巴胺治疗，92例（47%）接受了肠外营养。64例婴儿（33%）病程中并发II-IV级颅内出血（ICH），17例（9%）并发惊厥，23例（12%）并发气胸，21例（11%）并发败血症，10例（5%）并发坏死性小肠结肠炎。60例婴儿（31%）需要进行药物或手术关闭动脉导管未闭。11例婴儿（6%）发生囊性脑室周围白质软化，10例婴儿（5%）发生3-4期早产儿视网膜病变，35例婴儿（24%）在28日龄时接受了补充氧气治疗。出生时存在的不良结局危险因素包括：5分钟Apgar评分<7、出生体重<1000 g、男性以及在哥本哈根大学医院以外的其他医院出生。仅对于存活婴儿的不良结局而言，II-IV级ICH是唯一的显著危险因素。
