生存极限超早产儿的救治进展  

Progress on management of periviable extremely premature infants

作　　者：陈雯雯 陈超 Wenwen Chen;Chao Chen(Department of Neonatology,Children`s Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院新生儿科,上海201102

出　　处：《中华围产医学杂志》2022年第6期443-449,共7页Chinese Journal of Perinatal Medicine

摘　　要：生存极限超早产儿(periviable extremely preterm infant,PEPI)是指胎龄处于人类生存极限边缘,主要为胎龄<24周,或出生体重<500 g的超早产儿。PEPI的救治是围产医学中最复杂的问题之一。近年来PEPI的存活数量明显增多,存活者中半数以上没有严重神经系统损害。采用积极的医疗干预措施,可以降低PEPI生命早期和出院后短期随访的病死率,而不增加神经系统损害的风险。PEPI的临床决策不应限于基于群体数据的产前预测,更应注重生后的个体特征和生命轨迹,在充分协商后,由父母做出知情选择。在预后不确定的情况下,可以先开始复苏和给予重症监护治疗,之后再重新评估。目前PEPI的临床管理主要参照胎龄24~27周超早产儿的管理方案,但需要更加精细化地执行。Periviable extremely preterm infant(PEPI)refers to preterm infants born on the border of viability,mainly those with gestational age less than 24 weeks or birth weight less than 500 g.PEPI has increased in the past decades,and about half of the survivors live without severe neurodevelopmental impairment.The management of PEPI remains one of the most complex fields in perinatal-neonatal medicine.Active interventions can reduce the risk of morbidity and mortality in PEPI during early life and short-term follow-up after discharge without increasing the risk of neurodevelopmental impairment.Clinical decision-making about PEPI should not be restricted to population-based prenatal data but should mainly be based on postnatal individual characteristics and conditions.Parents should make an informed choice after detailed consultation with their physician.When the prognosis is uncertain,resuscitation and intensive care could be given and reassessed subsequently.Current interventions or treatments of PEPI refer to strategies for infants born at 24-27 gestational weeks,which need to be refined in practice.

关 键 词：婴儿 极度早产 挽救疗法 存活 临床管理 

分 类 号：R722.6[医药卫生—儿科]