美国俄亥俄州立大学医学院William A. Grobman团队研究了2014-2020年美国按胎龄和母亲种族和族裔分层的妊娠22周0天至25周6天活产新生儿的积极治疗趋势。这一研究成果发表在2022年8月16日出版的《美国医学会杂志》上。

妊娠22周0天至25周6天的围产期分娩是新生儿发病和死亡的主要来源，因此决定启动积极的救生治疗极具挑战性。

为了评估围产期活产新生儿积极治疗的频率是否随时间变化，以及积极治疗是否因出生时的胎龄、种族和族裔而不同，研究组使用美国国家卫生统计中心2014至2020年的出生数据，对美国妊娠22周0天至25周6天间无临床异常的61908例单胎活产进行了一项系列横断面描述性研究。

暴露因素为分娩年份、出生胎龄以及孕妇的种族和族裔，分为非西班牙裔亚洲/太平洋岛民、非西班牙裔黑人、西班牙裔/拉丁裔美洲人和非西班牙裔白人。主要结局为积极治疗，根据是否尝试治疗新生儿的决定，定义为表面活性剂治疗、出生时立即辅助通气、辅助通气持续时间超过6小时和/或抗生素治疗的组合。估计频率、平均年变化百分比（APC）和校正后风险比（aRR）。

在26986716例活产中，61908例（0.2%）为本研究纳入的围产期活产：5%为亚洲/太平洋岛民，37%为黑人，24%为西班牙裔，34%为白人；其中14%在22周出生，21%在23周出生，30%在24周出生，34%在25周出生。52%的新生儿接受了积极治疗。

2014-2020年，积极治疗的总频率（每年平均APC）显著增加（3.9%），所有种族和族裔亚群体（亚洲/太平洋岛民：3.4%；黑人：4.7%；西班牙裔：4.7%；白人：3.1%）和每个胎龄范围内（22周：14.4%和25周：2.9%）均有所增加。与白人新生儿（57.0%）相比，亚洲/太平洋岛民新生儿（46.2%；aRR为0.82），黑人新生儿（51.6%；aRR为0.90）和西班牙裔新生儿（48.0%；aRR为0.83）接受积极治疗的可能性显著降低。

研究结果表明，从2014年到2020年，美国在孕22周0天至25周6天分娩的活产婴儿积极治疗频率显著增加，但按种族和族裔划分的积极治疗率存在差异。

附：英文原文

Title: Trends in Active Treatment of Live-born Neonates Between 22 Weeks 0 Days and 25 Weeks 6 Days by Gestational Age and Maternal Race and Ethnicity in the US, 2014 to 2020

Author: Kartik K. Venkatesh, Courtney D. Lynch, Maged M. Costantine, Carl H. Backes, Jonathan L. Slaughter, Heather A. Frey, Xiaoning Huang, Mark B. Landon, Mark A. Klebanoff, Sadiya S. Khan, William A. Grobman

Issue&Volume: 2022/08/16

Abstract:

Importance  Birth in the periviable period between 22 weeks 0 days and 25 weeks 6 days’ gestation is a major source of neonatal morbidity and mortality, and the decision to initiate active life-saving treatment is challenging.

Objective  To assess whether the frequency of active treatment among live-born neonates in the periviable period has changed over time and whether active treatment differed by gestational age at birth and race and ethnicity.

Design, Setting, and Participants  Serial cross-sectional descriptive study using National Center for Health Statistics natality data from 2014 to 2020 for 61908 singleton live births without clinical anomalies between 22 weeks 0 days and 25 weeks 6 days in the US.

Exposures  Year of delivery, gestational age at birth, and race and ethnicity of the pregnant individual, stratified as non-Hispanic Asian/Pacific Islander, non-Hispanic Black, Hispanic/Latina, and non-Hispanic White.

Main Outcomes and Measures  Active treatment, determined by whether there was an attempt to treat the neonate and defined as a composite of surfactant therapy, immediate assisted ventilation at birth, assisted ventilation more than 6 hours in duration, and/or antibiotic therapy. Frequencies, mean annual percent change (APC), and adjusted risk ratios (aRRs) were estimated.

Results  Of 26986716 live births, 61908 (0.2%) were periviable live births included in this study: 5% were Asian/Pacific Islander, 37% Black, 24% Hispanic, and 34% White; and 14% were born at 22 weeks, 21% at 23 weeks, 30% at 24 weeks, and 34% at 25 weeks. Fifty-two percent of neonates received active treatment. From 2014 to 2020, the overall frequency (mean APC per year) of active treatment increased significantly (3.9% [95% CI, 3.0% to 4.9%]), as well as among all racial and ethnic subgroups (Asian/Pacific Islander: 3.4% [95% CI, 0.8% to 6.0%]); Black: 4.7% [95% CI, 3.4% to 5.9%]; Hispanic: 4.7% [95% CI, 3.4% to 5.9%]; and White: 3.1% [95% CI, 1.1% to 4.4%]) and among each gestational age range (22 weeks: 14.4% [95% CI, 11.1% to 17.7%] and 25 weeks: 2.9% [95% CI, 1.5% to 4.2%]). Compared with neonates born to White individuals (57.0%), neonates born to Asian/Pacific Islander (46.2%; risk difference [RD], 10.81 [95% CI, 12.75 to 8.88]; aRR, 0.82 [95% CI, [0.79-0.86]), Black (51.6%; RD, 5.42 [95% CI, 6.36 to 4.50]; aRR, 0.90 [95% CI, 0.89 to 0.92]), and Hispanic (48.0%; RD, 9.03 [95% CI, 10.07 to 7.99]; aRR, 0.83 [95% CI, 0.81 to 0.85]) individuals were significantly less likely to receive active treatment.

Conclusions and Relevance  From 2014 to 2020 in the US, the frequency of active treatment among neonates born alive between 22 weeks 0 days and 25 weeks 6 days significantly increased, and there were differences in rates of active treatment by race and ethnicity.

DOI: 10.1001/jama.2022.12841

Source: https://jamanetwork.com/journals/jama/article-abstract/2795269