改善22周妊娠存活率：哪些围产期干预措施重要？
本研究基于美国2019-2022年22周无畸形单胎活产数据，分析围产期干预对1年存活率的影响。共4994例活产中2769例接受至少一种干预。结果显示产前皮质类固醇、剖宫产、NICU入住和新生儿抗生素各自与1年存活改善相关，且干预数量越多累积获益越大。
要点
- 产前皮质类固醇、剖宫产、NICU入住和新生儿抗生素各自与22周活产1年存活改善相关。
- 接受2-3种或≥4种干预的病例较仅1种干预者1年存活概率更高，呈剂量-反应关系。
- 2019至2022年存活获益随时间改善，独立于干预数量或类型。
核心结论
- 产前皮质类固醇、剖宫产、NICU入住和新生儿抗生素各自与22周活产1年存活改善独立相关。
- 干预数量越多，累积存活获益越大，且2019至2022年存活获益随时间改善。
研究设计与样本
- 基于美国国家生命统计系统出生数据的回顾性队列研究，纳入2019至2022年22周无畸形单胎活产。
- 共4994例活产，其中2769例接受至少一种围产期干预并组成研究组。
主要发现
- 研究组中39.2%接受产前皮质类固醇，28.4%剖宫产，55.6%需立即通气，29.0%通气>6小时，78.7%入住NICU，22.8%接受表面活性物质，22.4%使用新生儿抗生素。
- 与仅接受1种干预者相比，接受2至3种干预者1年死亡风险aHR 0.64（95% CI 0.57-0.71），≥4种干预者aHR 0.41（95% CI 0.36-0.46），均P<.001。
- 产前皮质类固醇aHR 0.87（95% CI 0.79-0.96；P=.007），剖宫产aHR 0.76（95% CI 0.68-0.84；P<.001），NICU入住aHR 0.41（95% CI 0.36-0.46；P<.001），新生儿抗生素aHR 0.7（95% CI 0.6-0.82；P<.001），均与1年存活改善显著相关。
- 2019至2022年存活获益随时间改善，独立于干预数量（aHR 0.82；95% CI 0.72-0.94；P=.004）或类型（aHR 0.84；95% CI 0.74-0.96；P=.009）。
临床怎么用
- 对于22周活产儿，产前皮质类固醇、剖宫产、NICU入住和新生儿抗生素等干预可各自改善1年存活，干预数量越多累积获益越大。
- 上述结果可用于指导处于存活边缘的胎儿和新生儿的患者咨询与照护管理。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: There is a need to identify the specific interventions that benefit survival chances at the borderline of viability to inform care for patients seeking proactive life-prolonging care. OBJECTIVE: We evaluated the impact of perinatal interventions on the 1-year survival among 22-week live births. STUDY DESIGN: The study used the United States (U.S.) National Vital Statistics System Natality Data and included nonanomalous singleton live births at 22 weeks from 2019 to 2022. Cases were included if at least one of the interventions was documented: antenatal corticosteroids, cesarean delivery, neonatal intensive care unit (NICU) admission, assisted ventilation (immediate or for >6 hours), neonatal antibiotics for suspected newborn sepsis, or surfactant therapy. Cox proportional hazards regression models estimated adjusted hazard ratios (aHRs) for mortality within year one of life, controlling for maternal race, age, prior preterm birth, birth year, birth weight, infant sex, and individual treatment modalities. RESULTS: Of the 4994 live births, 2769 received ≥1 intervention and comprised the study group. Within this group, 39.2% received antenatal corticosteroids, 28.4% had a cesarean delivery, 55.6% required immediate ventilation, 29.0% ventilation >6 hours, 78.7% NICU admission, 22.8% surfactant therapy, and 22.4% neonatal antibiotics. A significant dose-response relationship was observed with cases receiving 2 to 3 interventions and ≥4 interventions demonstrating improved 1-year survival probability compared to those receiving only 1 intervention (aHR 0.64; 95% CI [0.57-0.71] and aHR 0.41; 95% CI [0.36-0.46], respectively; all P<.001). Survival benefits were improved over time from 2019 to 2022, independent of intervention number (aHR 0.82; 95% CI [0.72-0.94], P=.004) or type (aHR 0.84; 95% CI [0.74-0.96], P=.009). Individually, antenatal corticosteroids (aHR 0.87; 95% CI [0.79-0.96]; P=.007), cesarean delivery (aHR 0.76; 95% CI [0.68-0.84]; P<.001), NICU admission (aHR 0.41; 95% CI [0.36-0.46]; P<.001), and newborn antibiotics (aHR 0.7; 95% CI [0.6-0.82]; P<.001) were significantly associated with improved survival at 1-year of life. CONCLUSION: Antenatal corticosteroids, cesarean delivery, NICU admission, and neonatal antibiotics were each individually associated with improved 1-year survival at 22 weeks. A greater number of interventions cumulatively improved outcomes. These findings could help guide patient counseling and care management of fetuses and newborns at the cusp of viability. El resumen está disponible en Español al final del artículo.
引用
- Jaber S, Tran HN, Migliore M, et al. Improving 1-year survival at 22 weeks gestation: which perinatal interventions matter? Am J Obstet Gynecol MFM. 2026. PMID: 42114769. doi:10.1016/j.ajogmf.2026.101989
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。