Objective To investigate the survival, complications, growth and development of extremely preterm infants (EPI). Methods This study collected clinical data of EPI (<28 gestational weeks) admitted to our neonatal intensive care unit (NICU) from January 2020 to December 2023. The infants were categorized by outcome into death group, treatment withdrawal group, and survival group; by gestational age into<26 weeks group and ≥26 weeks group; and by birth weight into ≤750 g group and>750 g group. We analyzed the clinical characteristics, developmental outcomes of survivors, and identified prognostic risk factors through multivariate unconditional logistic regression analysis. Results A total of 64 extremely preterm infants were included. Among them, 3 cases were in the treatment withdrawal group(not included in the denominator for survival rate calculation), 46(75.41%) in the survival group, and 15(24.59%) in the death group. The proportion with a birth weight>750g in the survival group was significantly higher than that in the death group (P<0.05). Both gestational age and birth weight in the survival group were significantly greater than those in the death group (P<0.05). The top five complications among the 64 extremely preterm infants were neonatal respiratory distress syndrome (NRDS), early postnatal hyperglycemia, bronchopulmonary dysplasia (BPD), neonatal sepsis, and pulmonary infection. The survival group had significantly lower proportions of the following compared to the death group (P<0.05): mechanical ventilation, ≥2 doses of pulmonary surfactant (PS), NRDS grade Ⅲ-Ⅳ, pulmonary hemorrhage, discharge weight>10th percentile (P10) for corrected gestational age and sex, patent ductus arteriosus (PDA) size-to-weight ratio. Conversely, the survival group had significantly higher values than the death group (P<0.05) in: duration of proportion receiving PDA treatment, rate of ductus arteriosus closure, proportion requiring red blood cell transfusions, incidence of retinopathy of prematurity (ROP), length of hospital stay, hospitalization costs. Multivariate unconditional logistic regression analysis identified shock and PDA as independent risk factors affecting EPI (P<0.05). The ≥26 weeks group had significantly larger head circumference at 1 month of corrected gestational age compared to the<26 weeks group (P<0.05). Conclusion The survival rate of EPI is approximately 75%, which is positively correlated with gestational age and birth weight. Shock and PDA are independent risk factors affecting mortality outcomes in extremely preterm infants. There were no significant differences in long-term development among EPI of different gestational ages at birth, and no significant developmental differences were observed among EPI with different birth weights.
Key words
extremely preterm infants /
survival /
death /
complications /
development
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 谢幸, 孔北华, 段涛. 妇产科学[M]. 第9版. 北京: 人民卫生出版社, 2018.
[2] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 第5版. 北京: 人民卫生出版社, 2019.
[3] HIGGINS RD, JOBE AH, KOSO-THOMAS M, et al.Bronchopulmonary dysplasia: executive summary of a workshop[J]. J Pediatr, 2018, 197: 300-308.
[4] DOYLE L W, DAVIS PG, MORLEY CJ, et al.Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial[J]. J Pediatr, 2018, 197: 300-308.
[5] 中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识 (2019年版)[J]. 中华儿科杂志, 2019, 57(4): 252-257.
[6] FENTON TR.A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format[J]. BMC Pediatr, 2003, 3: 13.
[7] 张沂洁, 朱燕, 陈超. 早产儿发生率及变化趋势[J]. 中华新生儿科杂志, 2021, 36(4): 74-77.
[8] 吴天晨, 李驿馨, 石慧峰, 等.2017年至2022年中国早产流行病学特征及变化趋势[J]. 中华围产医学杂志, 2025, 28(2): 126-133.
[9] MYRHAUG HT, BRURBERG KG, HOV L, et al.Survival and Impairment of Extremely Premature Infants: A Meta-analysis[J]. Pediatrics, 2019, 143(2): e20180933.
[10] 蒋思远, 杨传忠, 田秀英, 等. 中国新生儿协作网出生胎龄22~25周超早产儿出院预后及治疗现状[J]. 中华儿科杂志, 2024, 62(1): 22-28.
[11] SU BH, HSIEH WS, HSU CH, et al.Neonatal outcomes of extremely preterm infants from taiwan: comparison with Canada, Japan, and the USA[J]. Pediatr Neonatol, 2015, 56(1): 46-52.
[12] NAKASHIMA T, INOUE H, SAKEMI Y, et al.Trends in bronchopulmonary dysplasia among extremely preterm infants in Japan, 2003-2016[J]. J Pediatr, 2021, 230: 119-125.
[13] ANDERSON JG, BAER RJ, PARTRIDGE JC, et al.Survival and major morbidity of extremely preterm infants: a population-based study[J]. Pediatrics, 2016, 138(1): e20154434.
[14] 余彦亮, 钟惠锋, 陈春, 等. 出生胎龄≤25+6周超早产儿的救治现状及预后分析[J]. 中华儿科杂志, 2023, 61(1): 36-42.
[15] 宗海峰, 林冰纯, 黄颖穗, 等. 胎龄21周+4超早产儿成功救治1例[J]. 中华围产医学杂志, 2024, 27(10): 860-864.
[16] 赵芳萍, 朱玉茹, 易彬, 等.370克超早产儿成功救治及随访1例[J]. 中华新生儿科杂志 (中英文), 2023, 38(12): 759-760.
[17] 夏磊, 关豪, 王文秀, 等. 超早产儿生存现状及预后分析[J]. 中华新生儿科杂志 (中英文), 2023, 38(6): 344-348.
[18] NIKOLIĆ MZ, SUN D, RAWLINS EL. Human lung development: recent progress and new challenges[J]. Development, 2018, 145(16): dev163485.
[19] CHAWLA S, BAPAT R, PAPPAS A, et al.Neurodevelopmental outcome of extremely premature infants exposed to incomplete, no or complete antenatal steroids[J]. J Matern Fetal Neonatal Med, 2013, 26(15): 1542-1547.
[20] 中华医学会围产医学分会, 中国医师协会新生儿科医师分会. 关于超早产儿救治的出生胎龄低限和分娩场所的建议[J]. 中华围产医学杂志, 2022, 25(2): 88-91.
[21] 中华医学会妇产科学分会产科学组. 早产临床防治指南 (2024版)[J]. 中华妇产科杂志, 2024, 59(4): 257-269.
[22] 齐敏, 张烨, 杨世炳, 等. 超早产儿肺出血临床特点及高危因素研究[J]. 中华新生儿科杂志 (中英文), 2023, 38(04): 200-204.
[23] ZHU Z, YUAN L, WANG J, et al.Mortality and morbidity of infants born extremely preterm at tertiary medical centers in China from 2010 to 2019[J]. JAMA Netw Open, 2021, 4(5): e219382.
[24] GENTLE SJ, FREEMAN A, PATEL RP, et al.Airway nitrite is increased in extremely preterm infants with bronchopulmonary dysplasia[J]. Respir Res, 2020, 21(1): 244.
[25] 刘太祥, 施丽萍. 超早产儿生后72 h内低血压发生的危险因素及预后分析[J]. 中国当代儿科杂志, 2023, 25(10): 1001-1007.
[26] 由凯, 富建华, 许学文, 等. 新生儿休克死亡相关因素分析[J]. 中国实用儿科杂志, 2010, 25(6): 469-471.
[27] 吴本清, 苏锦珍. 新生儿休克的早期识别与治疗[J]. 中华实用儿科临床杂志, 2017, 32(2): 88-90.
[28] 张华清, 彭华. 下腔静脉直径及塌陷指数在新生儿休克液体复苏中的应用进展[J]. 中华新生儿科杂志 (中英文), 2023, 38(12): 765-768.
[29] DAI Y, ZHU L, ZHOU Y, et al.Incidence of retinopathy of prematurity treatment in extremely preterm infants in China[J]. Paediatr Perinat Epidemiol, 2022, 36(3): 380-389.
[30] ZHU Z, WANG J, CHEN C, et al.Hospitalization charges for extremely preterm infants: a ten-year analysis in Shanghai, China[J]. J Med Econ, 2020, 23(12): 1610-1617.
[31] 杨玉兰, 孙宾宾, 屈小莉, 等. 早产儿矫正24月龄内体格发育及神经心理发育随访分析[J]. 中国儿童保健杂志, 2022, 30(10): 1123-1127.
[32] WANG X, TRABATTI C, WEEKE L, et al.Early qualitative and quantitative amplitude-integrated electroencephalogram and raw electroencephalogram for predicting long-term neurodevelopmental outcomes in extremely preterm infants in the Netherlands: a 10-year cohort study[J]. Lancet Digit Health, 2023, 5(12): e895-e904.
PDF(2064 KB)
