胎龄小于26周超早产儿单中心救治情况分析

Analysis of treatment of extremely premature infants with gestational age<26 weeks in single-center

目的探讨胎龄<26周超早产儿(extremely preterm infant,EPI)的救治及转归情况。方法2018年1月至2022年11月,在解放军总医院儿科医学部新生儿重症监护病房(neonatal intensive care unit,NICU)的收治患儿中,纳入胎龄<26周的EPI为研究对象。采用回顾性分析的方法,通过住院登记记录,查阅电子病历,收集研究对象住院期间的病历资料,记录患儿胎龄、出生医院、脑室周围脑室内出血(periventricular-intraventricular hemorrhage,PIVH)及转归等情况。统计各年度胎龄<26周EPI救治例数及其所占该年度EPI的比例,分析本院分娩的胎龄<26周的EPI情况、重度PIVH发生率及治愈好转率。结果2018年1月至2022年11月,解放军总医院儿科医学部收治的胎龄<26周EPI占EPI的比例分别为19.9%(38/191)、20.0%(36/180)、15.6%(14/90)、25.5%(26/102)、27.1%(29/107);除2020年,其余年份胎龄<26周EPI占EPI总数的比例呈逐年增高趋势。本院产科分娩的胎龄<26周EPI占胎龄<26周EPI的比例也呈增高趋势,各年度分别为0.0%(0/38)、5.6%(2/36)、14.3%(2/14)、15.4%(4/26)、41.4%(12/29);2021、2022年度,宫内转运EPI分别为4例、12例。各年度胎龄<26周EPI发生重度PIVH者占该年度胎龄<26周EPI的比例分别为29.0%(11/38)、36.1%(13/36)、28.6%(4/14)、34.6%(9/26)、27.6%(8/29)。各年度胎龄<26周EPI的治愈好转率分别为76.3%(29/38)、55.6%(20/36)、71.4%(10/14)、57.7%(15/26)、65.5%(19/29);相较于其他年度,2022年度虽收治23周EPI明显增多,但总体放弃治疗及死亡数明显减少,治愈好转率增高。结论2018年1月至2022年11月,解放军总医院儿科医学部收治的胎龄<26周EPI占EPI总数的比例呈逐年增高趋势,但重度PIVH发生率并未随之升高;与前几年比较,2022年对胎龄23周EPI的救治更加积极,治愈好转率增高。

Objective To investigate the treatment and outcome of extremely preterm infant(EPI)with gestational age<26 weeks.Method From January 2018 to November 2022,EPIs with gestational age<26 weeks in neonatal intensive care unit(NICU),Department of Pediatrics,the Chinese PLA General Hospital were included in the study.The medical records during hospitalization were collected through hospitalization registration records and electronic medical records,and the gestational age,birth hospital,periventricular-intraventricular hemorrhage(PIVH)and outcome of the infants were recorded by retrospective analysis.The annual number of EPIs with gestational age<26 weeks treated and their proportion in the annual number of EPIs were counted,and the incidence of severe PIVH and the cure or improvement rate were analyzed.Result From January 2018 to November 2022,the proportion of EPIs with gestational age<26 weeks in the total number of EPIs admitted was as follows:19.9%(38/191),20.0%(36/180),15.6%(14/90),25.5%(26/102)and 27.1%(29/107).Except for 2020,the number of EPIs with gestational age<26 weeks increased year by year.The number of EPIs with gestational age<26 weeks born in Department of Obstetrics of this Hospital increased respectively,accounting for 0.0%(0/38),5.6%(2/36),14.3%(2/14),15.4%(4/26)and 41.4%(12/29)of the annual number of EPIs with gestational age<26 weeks.Four and 12 cases of EPIs were transferred prenatally.Among each year the proportion of EPIs with severe PIVH at gestational age<26 weeks was 29.0%(11/38),36.1%(13/36),28.6%(4/14),34.6%(9/26)and 27.6%(8/29),respectively.The cure or improvement rate of EPIs with gestational age<26 weeks from 2018 to 2022 were 76.3%(29/38),55.6%(20/36),71.4%(10/14),57.7%(15/26)and 65.5%(19/29)respectively.Compared with other years,there was a significant increase in EPIs at 23 weeks in 2022,but the overall number of treatment abandonment and death was significantly reduced,and the rate of cure improvement was increased.Conclusion From January 2018 to November 2022,the proportion of EPIs with gestational age<26 weeks in the total number of EPIs in Faculty of Pediatrics,the Chinese PLA General Hospital increased gradually,but the incidence with severe PIVH does not change significantly.Compared with previous years,the treatment of EPIs at 23 weeks gestational age is more active in 2022,and the recovery rate increases.