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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (5): 325-330.DOI: 10.3969/j.issn.1673-5501.2022.05.001

• 论著 •    下一篇

中国新生儿协作网2019年行胎儿宫内手术和/或产前侵入性操作的极早产儿病死率的队列研究

武伟1，顾昕玥2，石静云3，赵芳萍3，蒋思远2，4，周文浩2，4，邱银萍1，曹云2，4   

  1. 1 宁夏医科大学总医院新生儿科银川，750004；2 复旦大学附属儿科医院国家卫生健康委员会新生儿疾病重点实验室（复旦大学）上海，201102；3 甘肃省妇幼保健院新生儿科兰州，730050；4 复旦大学附属儿科医院新生儿科上海，201102
  • 收稿日期:2022-08-25 修回日期:2022-10-05 出版日期:2022-10-25 发布日期:2022-10-25
  • 通讯作者: 邱银萍；曹云

The mortality of very preterm infant with intrauterine operations and/or invasive prenatal interventions in Chinese neonatal network in 2019: A cohort study

WU Wei1，GU Xinyue2， SHI Jingyun3，ZHAO Fangping3，JIANG Siyuan2，4，ZHOU Wenhao2，4，QIU Yinping1，CAO Yun2，4   

  1. 1 Department of Neonatology, General Hospital of Ningxia Medical University，Yinchuan 750004, China；2 National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Children's Hospital of Fudan University, Shanghai 201102, China；3  Department of Neonatology, Gansu Provincial Maternity and Childcare Hospital, Lanzhou 730050, China；4 Department of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China
  • Received:2022-08-25 Revised:2022-10-05 Online:2022-10-25 Published:2022-10-25
  • Contact: QIU Yinping, email: pyq1003@163.com；CAO Yun，email：yuncao@fudan.edu.cn

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摘要： 背景：近年来我国胎儿医学发展迅速，全国各地陆续开展了各种胎儿宫内手术，但目前胎儿医学干预效果评价多基于单中心、小样本数据并局限于围产期结局，缺乏胎儿生后近期和远期预后的多中心、大样本研究。 目的：描述2019年中国新生儿协作网（CHNN）57家NICU收治的极早产儿中接受胎儿宫内手术和/或产前侵入性操作者的现状及预后。 设计：队列研究。 方法：以CHNN收录的极早产儿为队列人群，以接受胎儿宫内手术和/或产前侵入性操作（胎儿镜激光凝固术、选择性减胎术、宫内输血、体腔内积液引流术、减羊水术、羊膜腔穿刺或绒毛膜取样术）者为暴露组，采用倾向性评分的方法1∶4匹配未接受产前干预的对照组，比较两组间病死率（NICU院内、生后28 d、生后7 d）和主要并发症［严重脑损伤、严重早产儿视网膜病、支气管肺发育不良（BPD）、坏死性小肠结肠炎和败血症］发生率。 主要结局指标：病死率。 结果：2019年CHNN数据库共收治极早产儿9 520例，接受胎儿宫内手术和/或产前侵入性操作患儿共187例（2.1%），其中选择性减胎术69例，羊膜腔穿刺或绒毛膜取样术66例，减羊水术42例，胎儿镜激光凝固术20例，宫内输血10例，体腔内积液引流术2例。暴露组极早产儿NICU全因病死率为15.5%（29/187），其中22例死亡发生在生后7 d内；最常见的并发症为BPD（41.7%）、败血症（11.8%）和严重脑损伤（9.4%）。匹配后与对照组患儿相比，接受产前干预的极早产儿NICU全因病死率及主要并发症发生率差异无统计学意义，暴露组生后7 d内全因死亡（RR=1.69，95%CI：1.06~2.71），早发败血症（RR=3.20，95%CI：1.28~7.99）发生风险高于对照组。 结论：CHNN 2019年NICU入院极早产儿中接受宫内手术和/或产前侵入性操作的患儿占2.1%，接受宫内手术和/或产前侵入性操作并不显著增加极早产儿NICU死亡或并发症的发生率。

关键词: 宫内手术, 产前侵入性操作, 极早产儿

Abstract: Background：In recent years, with the rapid development of fetal medicine in China, intrauterine operations have been widely carried out across the country. At present, the evaluation of fetal medical intervention effects is mostly based on single center with a small sample data and the limitation to the perinatal outcome. There is a lack of multicenter, large sample studies on the shortterm and longterm prognosis of fetuses after birth. Objective：To describe the current status and prognosis of very preterm infants who received intrauterine operations and/or invasive prenatal interventions in 57 NICUs of the Chinese Neonatal Network (CHNN) in 2019. Design：Cohort study. Methods：This study took CHNN very preterm infants as the cohort population. Infants who received intrauterine operations and/or invasive prenatal interventions (including fetoscopic laser photocoagulation, selective fetal reduction, fetal transfusion, shunt placement, amnioreduction, and amniotic fluid and/or chorionic villus sampling) were matched to infants without prenatal interventions using propensity scores by the ratio of 1 to 4. Mortality (in NICU, 28 days after birth and 7 days after birth) and major morbidities (severe brain injury, retinopathy ≥ stage Ⅲ, bronchopulmonary dysplasia, necrotizing enterocolitis ≥ stage Ⅱ and sepsis) were compared between the two groups. Main outcome measures：Mortality. Results：A total of 9 520 very preterm infants were admitted to 57 NICUs in CHNN in 2019. Among them, 187 (2.1%) infants received intrauterine operations and/or invasive prenatal interventions, including 69 selective fetal reduction, 66 amniotic fluid and/or chorionic villus sampling, 42 amnioreduction, 20 fetoscopic laser photocoagulation, 10 fetal transfusion, and 2 shunt placement. The NICU allcause mortality of very preterm infants undergoing intrauterine operations and/or invasive prenatal interventions was 15.5% (29/187), with 22 deaths occurring within 7 days after birth. The most common morbidities among infants with prenatal interventions were bronchopulmonary dysplasia (41.7%), sepsis (11.8%), and severe brain injury (9.4%). The NICU mortality and rates of major morbidities were not significantly different from infants with prenatal interventions and the matched control group. While the mortality within 7 days (RR=1.69, 95%CI:1.06~2.71) and the incidence of early onset sepsis (RR=3.20, 95%CI:1.28~7.99) were significantly higher in infants who received intrauterine operations and/or invasive prenatal interventions. Conclusion：Overall, 2.1% of very preterm infants admitted to Chinese NICUs received intrauterine operations and/or invasive prenatal interventions. Intrauterine operations and/or invasive prenatal interventions did not significantly increase mortality and morbidities among very preterm infants.

Key words: Intrauterine operations, Invasive prenatal interventions, Very preterm infants