出生胎龄≤25^(+6)周超早产儿的救治现状及预后分析

Management and prognosis of extremely preterm infants with gestational age≤25^(+6) weeks

目的探讨出生胎龄≤25^(+6)周超早产儿的救治现状、主要并发症及转归。方法横断面研究, 回顾分析2015年1月至2021年12月入住南方医科大学附属深圳妇幼保健院新生儿科出生胎龄≤25^(+6)周的233例超早产儿的临床资料, 包括围生期因素、治疗、并发症、预后等。根据出生胎龄、入院年份分组, 分析超早产儿的存活率、主要并发症、死因及随访资料。采用χ^(2)检验、Kruskal-Wallis秩和检验等方法进行组间比较。结果 233例出生胎龄≤25^(+6)周的超早产儿中男134例(57.5%)、女99例(42.5%), 出生胎龄为(24.6±0.9)周, 出生体重为710.0(605.0, 784.5)g。总存活率61.8%(144/233), 存活超早产儿中出生胎龄最小为22+2周, 出生体重最低为390 g。因不积极治疗自动出院41例(17.6%);住院积极治疗的192例超早产儿中死亡14例(7.3%), 因合并严重并发症自动出院34例(17.7%), 存活出院144例(75.0%)。7年间超早产儿存活率逐年增高(χ^(2)=26.28, P<0.001), 积极治疗后自动出院和死亡逐年下降(χ^(2)=14.09, P=0.027)。存活出院的超早产儿中, 未合并主要并发症的超早产儿占20.8%(30/144), 出生胎龄越小并发症越多(χ^(2)=7.24, P=0.044), 出生胎龄≤23^(+6)周的超早产儿均合并1种或多种并发症。出生胎龄越小有创通气时间越长(χ^(2)=29.14, P<0.001)。122例完成随访的超早产儿中大运动发育迟缓、语言发育迟缓、听力或视力损伤分别占17.2%(21/122)、8.2%(10/122)、17.2%(21/122)。结论出生胎龄≤25^(+6)周超早产儿救治难度大, 积极救治存活率逐年上升。虽主要并发症患病率偏高, 但随访大部分预后良好。

Objective To investigate the outcomes including major complications and prognosis of extremely preterm infants with gestational age≤25^(+6) weeks.Methods The cross-sectional study enrolled 233 extremely preterm infants with gestational age≤25^(+6) weeks who were admitted to the Department of Neonatology of Shenzhen Maternity and Child Healthcare Hospital from January 2015 to December 2021.The clinical data including perinatal factors,treatments,complications,and prognosis were extracted and analyzed.These extremely preterm infants were also grouped according to gestational age and year of admission to further analyze their survival rate,major complications,causes of death,and long-term outcomes.The comparisons between the groups were performed with Chi-square test and Kruskal-Wallis.Results Among these 233 extremely preterm infants,134(57.5%)were males and 99(42.5%)females.The gestational age was(24.6±0.9)weeks,the birth weight was 710.0(605.0,784.5)g,and the overall survival rate was 61.8%(144/233).Among the surviving extremely preterm infants,the earliest gestational age was 22+2 weeks and the lowest birth weight was 390 g.There were 17.6%(41/233)of extremely preterm infants had treatment withdrawn and were discharged in line with the will of guardians.Among the rest 192 extremely preterm infants managed with aggressive treatments,14(7.3%)died in hospital and 34(17.7%)had treatment withdrawn later due to severe complications.Of the 192 extremely preterm infants,144(75.0%)survived,and the survival rate increased year by year(χ^(2)=26.28,P<0.001)while the mortality decreased year by year(χ^(2)=14.09,P=0.027).Among the survivors,20.8%(30/144)had no major complications,and the incidence of complications was also negatively related with the gestational age(χ^(2)=7.24,P=0.044),and the length of invasive ventilation was negatively related to the gestational age(χ^(2)=29.14,P<0.001).In the group of less than 23^(+6) weeks,all extremely preterm infants had one or more major complications.The follow-up were completed in 122 infants and revealed that delayed motor development,language retardation,and hearing and vision impairment accounted for 17.2%(21/122),8.2%(10/122)and 17.2%(21/122),respectively.Conclusions Extremely preterm infants with gestational age≤25^(+6) weeks are difficult to treat,but the survival rate of infants undergoing aggressive treatments increases year by year.Although the prevalence of major complications is still high,most extremely preterm infants have acceptable prognosis during follow-up.