Influence of Perinatal Factors on Limit of Viability in Extremely Low Birth Weight Infants

影響超低出生體重兒存活界限之週産期因素

蘇百弘(Bai-Horng Su) ； 林鴻志(Hong-Chih Lin) ； 彭慶添(Ching-Tien Peng) ； 蔡長海(Chang-Hai Tsai)

《Acta Paediatrica Sinica》 40卷2期 (1999/04) Pp. 87-91

https://doi.org/10.7097/APS.199904.0148

摘要

本研究以在1997年1月至1998年5月間，住進中國醫藥學院附設計醫院新生兒加護病房，出生體重小於1000公克之超低出生體重兒爲回溯分析之對象。有先天性異常及死産之病例不列入研究。以存活出院爲最終結果。總共收集個新生兒。平均懷孕週數爲25.8±1.8週，平均出生體重爲772±114公克。存活率爲48.8%。最小健全存活例爲懷孕23週，出生體重530公克之女嬰。對新生兒死亡有意義影響的分界點爲：懷孕週數24小於週，(odds ratio，6.11，信賴區間，2.01~18.63)，出生體重700小於公克(odds ratio，2.65，信賴區間，1.09~6.39)。兩個最有意義且分別獨立影響新生兒存活的因素爲：懷孕週數小於24週(odds ratio，9.24，信賴區間，2.53~33.76)及生後早期使用Dexamethasone預防慢性肺疾病(odds ratio，35.83信賴區間，7.03~183)。本研究顯示，爲了進一步降低新生兒死亡率，必須加強週産期照顧及促進女健康預防超早産兒及低出生體重兒的發生。對於大於或等於24週之懷孕做出積極的醫療計劃應是合理可期的。最後，除非能證實生後早期使用Dexamethasone預防慢性肺來安全的治療，否則不應常規使用圩超低出生體重兒。

關鍵字

超低出生體重兒 ； 存活界限 ； 週産期因素

並列摘要

This retrospective study investigated the influence of perinatal factors on the limit of viability in extremely low birth weight (ELBW) infants. From January 1997 to May 1998, all infants weighing less than 1000 gm admitted to NICU of China Medical College Hospital were enrolled in this study. Stillborn infants and infants with congenital anomaly were excluded. The end outcome was survival of the infants (defined as alive at discharge). Eighty-four infants were included in this study. Their mean gestational age (GA) was 25.8±1.76 weeks, mean birth weight (BW) was 772±114gm, and overall survival rate was 48.8%. The smallest intact survival was afemale infant of GA 23 weeks and BW530gm. Early neonatal mortality rate (＜7 days) was 26.2% (23/84). The cut off levels, below which mortality significantly increased, were GA＜24 weeks and BW＜700 gm (odds ratio, 6.11, confidence interval, 2.01 to 18.63 for GA, odds ratio, 2.65, confidence interval, 1.09 to 6.39 for BW). The two most significant factors which independently affected neonatal survival were GA＜24 weeks and early neonatal dexamethasone treatment for the prevention of chronic lung disease (odds ratio, 9.24, confidence interval, 2.53 to 33.76 for GA, odds ratio, 35.83, confidence interval, 7.03 to 183 for dexamethasone treatment). We conclude that in order to further reduce neonatal mortality, efforts should be made in the areas of prenatal care and women’s health to prevent extreme prematurity and low birth weight infants. In the case of an impending delivery of an ELBW infant, an active plan of management for all gestations 24 weeks seems appropriate. Finally, unless it is proven to be safe, early neonatal dexamethasone treatment for prevention of chronic lung disease should not be routinely used in ELBW infants.

並列關鍵字

extremely low birth weight infant ； perinatal factors ； limit of viability