Background

Since 2010, most tertiary care hospitals in Australia have changed how they care for extremely premature infants. However, in-hospital and longer-term outcome data have suggested unchanged or even worse health outcomes in later epochs, especially respiratory outcomes. This study examined the trend in outcomes since these changes were introduced, particularly the prevalence of chronic neonatal lung disease (CLD).

Methods

This is a retrospective cross-sectional analysis of data from the Neonatal Intensive Care Units’ (NICUS) database of all perinatal intensive care units in New South Wales and the Australian Capital Territory, including infants born at ≥ 24 and ≤ 28 weeks of gestational age in tertiary perinatal units between January 1, 2010, and December 31, 2020. Temporal trends and changes in primary outcome were examined by linear and adjusted multivariable logistic regression models.

Results

This study included 3258 infants. We saw significant changes in antenatal magnesium sulfate (75% increase), delayed cord clamping (66% increase), delivery room intubations (30% decrease), any time (20% decrease), duration on mechanical ventilation (100-hour decrease), and hours on noninvasive ventilation (200-hour increase). Mortality decreased from 17% to 6%. The incidence of CLD increased significantly even when adjusted for confounders (15% increase). Any time and mean hours spent on mechanical ventilation significantly increased the odds of CLD. This study could not find a significant association of any of the protective antenatal treatments on CLD.

Conclusions

The last decade saw a significant improvement in survival and survival to discharge without major morbidity. There was increased use of magnesium sulfate, delayed cord clamping, and less invasive respiratory management of extremely preterm infants. The avoidance of mechanical ventilation may impact the incidence of CLD.

中文翻译：

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以更多慢性肺病为代价提高生存率？新南威尔士州和澳大利亚首都特区出生的极早产儿的当前管理和结果：2010-2020

背景

自 2010 年以来，澳大利亚大多数三级护理医院都改变了对极早产儿的护理方式。然而，院内和长期结果数据表明，后期的健康结果没有变化甚至更糟，尤其是呼吸系统结果。这项研究考察了自这些变化发生以来的结果趋势，特别是慢性新生儿肺病（CLD）的患病率。

方法

这是对新南威尔士州和澳大利亚首都地区所有围产期重症监护病房的新生儿重症监护病房 (NICUS) 数据库数据的回顾性横断面分析，其中包括 ≥ 24 周和 ≤ 28 周胎龄出生的婴儿2010 年 1 月 1 日至 2020 年 12 月 31 日期间，在第三级围产期单位中进行了调查。通过线性和调整后的多变量逻辑回归模型检查了主要结局的时间趋势和变化。

结果

这项研究包括 3258 名婴儿。我们看到产前硫酸镁（增加 75%）、延迟脐带结扎（增加 66%）、产房插管（减少 30%）、任何时间（减少 20%）、机械通气持续时间（减少 100 小时）的显着变化和无创通气时间（增加 200 小时）。死亡率从 17% 下降到 6%。即使在调整混杂因素后，慢性肺病的发病率仍显着增加（增加 15%）。机械通气的任何时间和平均小时数都会显着增加慢性肺病的几率。这项研究未能发现任何保护性产前治疗与 CLD 之间存在显着关联。

结论

在过去的十年中，生存率和出院生存率均得到显着改善，且无重大发病情况。硫酸镁的使用增加，延迟脐带结扎，以及对极早产儿的微创呼吸管理。避免机械通气可能会影响慢性肺病的发病率。