评估生存和神经发育的新生儿非常早产在葡萄牙三级中心。

IF 1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
Margarida Camacho-Sampaio, Catarina Cordeiro, Catarina Leuzinger-Dias, Ana Dias, Dolores Faria, Adelaide Taborda
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引用次数: 0

摘要

导言:医疗保健的进步大大提高了全球早产儿的存活率,导致有神经系统风险的新生儿人口增加。了解特定孕龄结果对于指导和提供最佳医疗护理至关重要。本研究旨在评估胎龄对极早产儿死亡率和神经发育的影响。作为次要目标,我们旨在确定围产期因素对神经发育障碍或死亡的综合结局的影响。方法:我们对2013年至2021年在葡萄牙一家三级妇产医院新生儿重症监护室出生的所有孕周未满32周的婴儿进行了回顾性队列研究。神经发育在矫正年龄24个月时进行评估,使用格里菲斯心理发育量表II。中度至重度神经发育障碍被认为存在以下标准中的至少一个:整体发育商< 70,脑瘫,严重视力障碍或深度感音神经性耳聋。结果:有311名极早产儿被评估为合格,10.9%的新生儿死亡,11.9%的随访损失。对274例婴儿进行了神经发育评估,其中6.2%(17/274)为中度至重度神经发育障碍,7.5%(5/67)为28周前出生,5.8%(12/207)为28 - 31周出生。4.7%的病例证实全球发展商数< 70。脑瘫占3.3%,重度视力障碍占0.7%,重度感音神经性耳聋占0.7%。无中度至重度神经发育障碍的存活率在25周时超过死亡率,从28周开始为60%。在多变量logistic回归分析中,胎龄被确定为中重度神经发育障碍或死亡的保护因素(aOR 0.81;CI 95% 0.68 - 0.98),而男性(aOR 3.19;CI 95% 1.57 - 6.71)和气管插管复苏(aOR 8.17;CI 95% 3.16 ~ 20.96)为独立危险因素。结论:本研究重申胎龄是极早产儿生存和神经发育结局的关键决定因素,28周前出生的早产儿面临更高的死亡风险和严重的神经发育障碍。了解当地存活率和神经发育结局对于指导围产期决策和为早产儿父母提供准确的循证咨询至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of Survival and Neurodevelopment in Neonates Born Very Preterm at a Tertiary Centre in Portugal.

Introduction: Advances in medical care have significantly improved survival rates for preterm infants globally, leading to an increase of population of newborns at neurological risk. Knowledge of gestational age-specific outcomes is essential to guide and provide the best medical care. This study aimed to evaluate the impact of gestational age in mortality and neurodevelopment of very preterm infants. As a secondary objective, we aimed to determine the influence of perinatal factors on the combined outcome of neurodevelopmental impairment or death.

Methods: We conducted a retrospective cohort study of all infants born before completing 32 weeks of gestational age, admitted to the Neonatal Intensive Care Unit in a tertiary maternity hospital in Portugal from 2013 to 2021. Neurodevelopment was assessed at 24 months of corrected age, using Griffiths Mental Developmental Scales II. Moderate to severe neurodevelopment impairment was considered in the presence of at least one of the following criteria: global development quotient < 70, cerebral palsy, severe visual impairment or profound sensorineural deafness.

Results: There were 311 very preterm infants assessed for eligibility, 10.9% neonatal deaths and 11.9% losses to follow-up. Neurodevelopment evaluation was performed on 274 infants, of whom 6.2% (17/274) had moderate to severe neurodevelopment impairment: 7.5% (5/67) born before 28 weeks of gestational age and 5.8% (12/207) between 28 - 31 weeks. Global development quotient < 70 was verified in 4.7% of cases. Cerebral palsy was diagnosed in 3.3%, severe visual impairment in 0.7% and profound sensorineural deafness in 0.7%. The survival rate without moderate to severe neurodevelopment impairment exceeded deaths at 25 weeks and was > 86% from 28 weeks onward. In multivariable logistic regression analysis, gestational age was identified as a protective factor for moderate to severe neurodevelopment impairment or death (aOR 0.81; CI 95% 0.68 - 0.98), whereas male sex (aOR 3.19; CI 95% 1.57 - 6.71) and resuscitation with tracheal intubation (aOR 8.17; CI 95% 3.16 - 20.96) were independent risk factors.

Conclusion: This study reaffirms gestational age as a key determinant of survival and neurodevelopmental outcomes in very preterm infants, with those born before 28 weeks facing higher risks of mortality and severe neurodevelopmental impairments. Understanding local survival rates and neurodevelopmental outcomes is paramount for guiding perinatal decision-making and providing accurate evidence-based counseling to parents of preterm infants.

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来源期刊
Acta medica portuguesa
Acta medica portuguesa MEDICINE, GENERAL & INTERNAL-
CiteScore
1.90
自引率
16.70%
发文量
256
审稿时长
6-12 weeks
期刊介绍: The aim of Acta Médica Portuguesa is to publish original research and review articles in biomedical areas of the highest standard, covering several domains of medical knowledge, with the purpose to help doctors improve medical care. In order to accomplish these aims, Acta Médica Portuguesa publishes original articles, review articles, case reports and editorials, among others, with a focus on clinical, scientific, social, political and economic factors affecting health. Acta Médica Portuguesa will be happy to consider manuscripts for publication from authors anywhere in the world.
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