Kramer W B, Saade G R, Goodrum L, Montgomery L, Belfort M, Moise K J
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
J Perinatol. 1997 Nov-Dec;17(6):439-43.
To record the effect of aggressive perinatal management on neonatal outcome in the very premature infant.
A retrospective chart review of 114 infants born between 23 and 27 weeks' gestation, managed by one perinatal transport service at one hospital between July 1989 and December 1993. Fetuses > 23 weeks' gestation were considered viable and were managed with tocolytics, antibiotics, and surfactant at the discretion of the treating physician. Morbidity and mortality rates in the first 6 months, including stillbirths were analyzed. A major neurologic condition was defined as ultrasonographic evidence of grade 3 or 4 intraventricular hemorrhage or periventricular leukomalacia.
Both neonatal mortality rate and the incidence of stillbirths decreased with advancing gestational age. Of 24 infants born at 23 weeks' gestation, 33% were stillborn and 13% were alive at 6 months. This survival rate improved to 48% for infants delivered at 24 weeks' gestation, and to 68%, 75%, and 71% for those delivered at 25, 26, and 27 weeks' gestation, respectively. The percentage of infants who survived without a major neurologic condition increased with advancing gestational age at delivery from 13% at 23 weeks' gestation to 40% at 24 weeks, 48% at 25 weeks, 70% at 26 weeks, and 71% at 27 weeks. The incidence of retinitis of prematurity, respiratory complications, and days spent in the hospital decreased with greater gestational age.
An active plan of management for all gestations of > 23.9 weeks seems appropriate.
记录积极的围产期管理对极早产儿新生儿结局的影响。
对1989年7月至1993年12月间在一家医院由一个围产期转运服务机构管理的114例孕23至27周出生的婴儿进行回顾性病历审查。孕龄>23周的胎儿被视为可存活胎儿，由治疗医生酌情使用宫缩抑制剂、抗生素和表面活性剂进行管理。分析前6个月的发病率和死亡率，包括死产情况。主要神经系统疾病定义为3级或4级脑室内出血或脑室周围白质软化的超声证据。
新生儿死亡率和死产发生率均随孕龄增加而降低。孕23周出生的24例婴儿中，33%为死产，13%在6个月时存活。孕24周出生的婴儿存活率提高到48%，孕25、26和27周出生的婴儿存活率分别为68%、75%和71%。无主要神经系统疾病存活的婴儿百分比随分娩时孕龄增加而增加，从孕23周时的13%增至孕24周时的40%、孕25周时的48%、孕26周时的70%和孕27周时的71%。早产儿视网膜病变、呼吸并发症的发生率以及住院天数随孕龄增加而减少。
对所有孕龄>23.9周的情况采取积极的管理计划似乎是合适的。
